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BOSTON UNIVERSITY 
LIBRARIES 




Nursing-Social Work 
Library 



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A History of Nursing 



9305 



A History of Nursing 

From the Earliest Times to the Present Day 

with Special Reference to the Work of 

the Past Thirty Years 



Edited, and in Part Written, by 

Lavinia L. Dock, r. n. 

Secretary of the International Council of Nurses, Graduate of 
Bellevue Training School, New York City 



In Four Volumes 
Volume IV 



With 34 Illustrations 



G. P. Putnam's Sons 
New York and London 






Copyright, 1912 

BY 

LAVINIA L. DOCK 



The work of preparing Vols. Ill and IV has been contributed for the service of 
the nursing profession, and the amount accruing from the sales is to be utilised for 
the fund of the International Council of Nurses. 



Sixth Impression 



Made in the United States of America 



CONTENTS 

PAGE 

CHAPTER I 

THE RISE OF THE GERMAN FREE SISTERS . . I 

CHAPTER II 

OUTLINES OF PIONEER WORK IN SWITZERLAND, 

HOLLAND, AND BELGIUM 5 2 

CHAPTER III 
MODERN NURSING IN AN ANCIENT SETTING . . 79 

CHAPTER IV 
NURSING IN NEW CONTINENTS . . . .122 

CHAPTER V 
NURSING SISTERS OF THE ORIENT . . . 229 

CHAPTER VI 
SOME ISLAND HOSPITALS AND NURSES . . 288 

BIBLIOGRAPHY ..•••*• 3 2 3 

INDEX • 33 1 



111 



ILLUSTRATIONS 

PAGE 

Nuns in Class .... Frontispiece 

Sister Agnes Karll 8 

Founder and President, German Nurses' Association. 

A Business Meeting of the Officers of the 

German Nurses' Association ... 32 

Sister Agnes Karll to the right. 

Miss J. C. van Lanschot Hubrecht . . 68 

President, Dutch Nurses' Association. 

Miss C. J. Tilanus 68 

Late President, Dutch Nurses' Association. 

Amy Turton, the Pioneer of Modern Nurs- 
ing in Italy 86 

Grace Baxter 100 

Superintendent, Blue Cross Nurses in Naples. 

Dorothy Snell 112 

Superintendent of Nurses, Queen Helen's Training School 
in Rome. 

A Ward in the Polyclinic Hospital, Rome . 116 

Sister Marie Zomak and a Group of Spanish 

Probationers ...... 120 

Mary Agnes Snively 134 

Taken when Lady Superintendent, Toronto General 
Hospital. • 



vi Illustrations 

PAGB 

Norah Livingston . . . . , . 134 

Lady Superintendent, Montreal General Hospital Train- 
ing School for Nurses. 

A Nurse in Labrador Sculling for Supplies 172 

By courtesy of the American Journal of Nursing. 

Julia Rachel Ayres 180 

Late Matron of Alfred Hospital, Melbourne, Victoria. 

Susan B. McGahey 180 

Hon. Vice-President. International Council of Nurses 
from Australia. 

A Group of St. Helen's Nurses . . .208 
Akenehi Hei 212 

The first Maori Nurse fully trained and qualified to 
register. 

Nurse Akenehi Hei 212 

On duty in her Tent Hospital. 

Grace Neill 216 

First Assistant Inspector of Hospitals and Asylums, 

New Zealand. 

Hester Maclean 216 

Assistant Inspector of Hospitals and Asylums, New Zealand ; 
Editor of Kai Tiaki. 

English Hospital, Zanzibar ; Miss Breay and 

Miss Brewerton in the Background . 224 

Cama Hospital, Bombay . . . .242 

Miss Tindall handing instruments. 

Martha Phullo 244 

A Brahman Nurse, Lucknow Hospital. 



Illustrations vii 

PAGE 

A Parsee Trained Nurse .... 244 

By courtesy of the Presbyterian Board of Missions. 

Miss M. E. McDonnell and Nurses at Neyoor 250 

The Empress Komeyo Distributing Medicines 

in her Charity Hospital . . .256 

Choko Suwo 276 

The first Japanese Nurse to undertake District Nursing. 

Take Hagiwara 276 

Red Cross Superintending Sister and Hon. Vice-President, 
International Council of Nurses. 

Chinese Pupil Nurses ..... 280 

By courtesy of the American Journal of Nursing. 

Esther Shields and her First Class of 

Corean Nurses 286 

A Group of Cuban Nurses .... 292 

M. Eugenie Hibbard 300 

A leader in Cuban Nursing. 

Isabel McIsaac 3°6 

Formerly Superintendent of the Illinois Training School 
and then Interstate Secretary ; Head, Army Nurse Corps. 

French Sisters of the Leper Colony of 

Manila 3 10 

By courtesy of the American Journal of Nursing. 



A HISTORY OF NURSING 



CHAPTER 1 

THE RISE OF THE GERMAN FREE SISTERS 

ONE who found it interesting to study the calling 
of the nurse, under the varied forms it took on 
in its evolution from the Middle Ages to the present 
day, would have been richly rewarded by a visit to 
Germany at the end of the last century. There, 
side by side, in full panoply, with all their character- 
istic features still in the bloom of vigorous life, 
could have been found nursing orders illustrating 
each historic variation, each successive phase in re- 
ligious and economic status, as rural, feudal Germany 
changed to a modern industrial empire. 

The industrial revolution, silently and irresistibly 
advancing, altered nursing communities, too, as it 
shook the foundations of home, turned wealth away 
from the convent, built the factory town, and cast 
thousands of women out into a new world to support 
themselves and, often, others dependent upon them, 
as they best might. The churchly orders that had 
been so harmoniously adapted to the social conditions 
of a different age saw their supremacy slipping away. 

VOL. IV. — I I 



2 A History of Nursing 

Germany shows perfect examples of hardworking 
and efficient Catholic nursing orders. They are 
practical, and follow the lead of medical science, but 
their numbers no longer sufficed to meet demands, 
nor did they as yet open secular schools. Then came 
the deaconess Motherhouses, but they, too, soon 
found that their patriarchal basis was too limited — ■ 
they could not expand indefinitely. Next were the 
first large secular schools for nurses upon the English 
pattern, Victoria House in Berlin and the Nursing 
Association of the City of Hamburg. The former 
was the creation of the Empress Frederick, who was 
a woman of advanced views. 1 Fraulein Louise 
Fuhrmann, the first superintendent of the house, in 
an account of it which she wrote in 1893, 2 said that 
the Empress had two purposes in view : one to prepare 
nurses for the care of the sick in their own homes, so 
that they might there have the same skilled care as 
in hospitals, and the other to open to educated young 
women an honourable and blessed vocation free from 
all the restraints of ' ' confession. ' ' This meant simply 
that pupils were not to be limited to one religious 
faith, but should be accepted without reference to 
their creed. Though it seems a matter of course 

1 In 1869, the great scientist Virchow gave a lecture before an 
association of women in Berlin, in which he declared that nursing 
should be organised on strictly secular lines, with purely humanitar- 
ian purposes, and urged the following proposals: 1. Men's wards 
should be nursed by women. 2. Every large hospital should have 
a training school. 3. Small localities should have training com- 
mittees. 4. Nurses should unite in organisations. 5. Special 
institutes should provide preparatory teaching in hygiene, dietetics, 
etc. Ges. Abhandl., off. Med., vol. ii., pp. 55-56. 

3 Report of the Congress of Hospitals and Dispensaries, World's 
Fair, Chicago, 1893. 



The German Free Sisters 3 

now, it was revolutionary, or at least daring, 
then. 

The Empress laid her views before the Society 
of Domestic Hygiene, of which she was patroness, 
and the school began in a small way in 1881-82, 
without definite hospital connection, but finally, in 
1886, with Fraulein Fuhrmann, who had meantime 
been trained at the Nightingale school at St. Thomas's, 
as its head, it was attached as an independent as- 
sociation to the public hospital at Friedrichshain, 
where the nurses were to receive their training. 
There was a board of trustees, and a very pleasant 
and attractive home was built for the pupils. The 
training lasted for one year, but the pupils signed a 
three-year contract, and after this term were free 
either to leave the association or to remain in its 
service throughout their lives. If they chose the 
latter, they were supported in sickness and old age, 
the general plan being similar to that of the religious 
orders, though the whole standard of living was more 
ample and a far greater degree of personal liberty 
allowed. At sixty, if in the service of the associa- 
tion, the nurses received pensions. (This detail has 
recently been altered. They are now insured.) 
Victoria House, in its day, was considered to be ex- 
tremely advanced. It has always attracted a superior 
type of women and they enjoy the advantages of a 
good position. Its pupils, however, are badly over- 
worked in the course of their training, owing, no 
doubt, to the necessity of making thrifty contracts 
with the city hospitals for their services. 

The Hamburg nurses, whose home is the Erica 
House at the immense Eppendorf Hospital, were 



4 A History of Nursing 

organised on similar lines. If the nurses, at the end 
of their hospital training, separated themselves from 
the control of the association in the management of 
which they had no share, they then ceased to have 
any claim on it or any right to its benefits. The 
same arrangement and the same defects continued 
in the associations of the Red Cross, which, after the 
war of 1870, had a period of remarkable growth, and 
developed thirty or forty Motherhouses for the train- 
ing of nurses. Within one generation, these houses 
collected under their wings a staff of more than three 
thousand Sisters, and turned the tide in the direction 
of religious freedom, for the Red Cross necessarily 
carried on a lively competition with the religious or- 
ders for desirable probationers; religious tests were 
discarded, and a free intellectual atmosphere was 
encouraged by the dedication to large national 
service and by the stimulus of international relation- 
ships. The ideals of the Red Cross were drawn on 
heroic lines: the love of country, the service of the 
Fatherland, and even beyond that, of humanity, — 
for no frontiers were known to the succour offered 
to the wounded or calamity-stricken. But the Red 
Cross Motherhouses, like the religious orders, were 
hampered by the necessity of supporting a large staff 
of workers and maintaining them in their old age or 
invalidism. The nurses were, so to speak, the tools 
of charity, receiving shelter, food, clothing, pocket 
money, and provision for old age, and in return for 
this, being bound to the Motherhouse for life. In 
the struggle for existence the competition between 
nursing associations often assumed a cut-throat 
character, and many Red Cross Sisters were over- 



The German Free Sisters 5 

worked, undert aught, and in short, exploited. The 
course of instruction given never exceeded six 
months, and teaching was often entirely sacrificed 
to the exigencies of getting work done. This was not 
always the case; there are some excellent Red Cross 
hospitals, and the service has attracted an admirable 
and talented set of women. 

Of progressive tendencies, also, in its recognition 
of the economic situation, was the Evangelische 
Diakonie Verein. This association owed its incep- 
tion to Professor Zimmer, who was for some time 
its director, and who recognised the necessity of 
opening new fields of occupation to young women 
of good education. Professor Zimmer held that 
the Sisters joining the society should retain as much 
individual freedom and independence as possible. 
They, therefore, after passing through definite pre- 
paratory stages, shared in the management of the 
society's affairs, and were expected to choose their 
own work, a radical departure from the custom of 
the older associations. It retained, however, a 
strongly religious stamp, being almost as defin- 
itely confessional as the deaconess house. The 
society offered three branches of work: nursing, 
teaching, and household economy. These different 
professions were taught in various selected institu- 
tions, and paths of promotion led to the higher 
posts, and to the inner circle of Verbandsschwestern to 
which the Sisters might pass by election from the 
outer circle of Vereinsschwestern. The Diakonie 
Verein was at first very successful; it soon became 
self-supporting, and attracted a superior set of 
women. It now (191 1) numbers about one thousand 



6 A History of Nursing 

members, but seems to have attained its maximum 
of growth. 

There were also nurses trained by the modern 
societies of St. John, usually women of good family 
who would not voluntarily work for a living, and were 
satisfied with a superficial training for philanthropic 
work, 1 and cottage nurses, trained in rural districts 
or in provincial towns, who were expected to perform 
the labours of five women (mother, nurse, cook, 
cleaner, and housekeeper) in the homes of the poor, 
and whose willing patience and industry often ex- 
cited the envious admiration of philanthropists from 
countries where women were not quite so strong or 
so submissive. 

x The Rules of the Johanniter-Orden say: The time of training 
shall be as long as the Motherhouse deems necessary for giving a 
good training, but not over six months. . . . 

Neither probationer nor Sister receives salary. Their service is a 
voluntary labour of love for suffering humanity and to the glory of 
God. After training, the Sisters of St. John were to return to their 
own homes and apply their knowledge for the benefit of the poor, so 
far as possible. They were to respond to calls from the head of the 
order when they were needed, either for war, epidemic, or some 
special emergency in the hospitals of the order. They were not to 
join other associations, except such as were allied to their order. 
The report for 1905 shows 1099 nursing Sisters, of whom 964 were 
fit for service, and 85 were ill. For various reasons the rest were not 
in line of duty. The hospital training was given in deaconess estab- 
lishments or others with which the Order of St. John affiliated. 10.7 
per cent, of the Johanniterinnen had devoted themselves to the 
deaconess service. During the year, 1 19 Sisters had been detached 
from the order, either because of chronic illness or precarious financial 
situation, or because, contrary to their promise, they had taken up 
private nursing for pay. In this case they had to refund the cost 
of their training, while in all cases of separation their badges had 
been recalled. Thirty-six had died, 296 had been devoting them- 
selves to district nursing, while 255, either through illness of their 
relatives or themselves, had been unable so to serve. 



The German Free Sisters 7 

At the beginning of the new century all the signs 
indicated the coming of a change in German nursing. 
The associations whose more or less rigid forms we 
have outlined were wholly unable to meet the de- 
mands of an adequate public hospital service, and 
yet a steady exodus of nurses from their gates was 
going on, and hundreds of women, driven chiefly by 
the need of earning a more ample living, but partly 
also by revolt against an arbitrarily narrowed exist- 
ence and starved personality, were leaving the 
deaconess orders, the Red Cross service, and the 
nursing associations, and, lonely and isolated, atoms 
tossed about in the labour market, were trying to 
support themselves at private duty or in positions. 
They were called the "Free" or the "Wild" Sisters. 
In reality these were pioneers in the revolt against 
the unpaid labour of women. They had been toiling 
for a mere subsistence. So much did the Mother- 
houses regard this as the order of nature, that they 
could not dream of altering it, nor would they have 
known how to do so. The problem facing the free 
Sisters was to obtain a living wage ir competition 
with Motherhouses partly supported by charity or 
endowments, which had set the price for nursing 
service at a minimum impossible for those who were 
self-dependent workers. Behind and over the eco- 
nomic situation was the power of the Church, here- 
tofore the chief employer of women. A foreign 
nurse, observing these things sympathetically in 
1899, wrote of the free Sisters: "Their lives are 
rather forlorn. The doctors and patients do not like 
them as well as the deaconesses (or pretend they do 
not), they are meagrely paid, and have not learned 



8 A History of Nursing 

to strengthen one another. One longs to help them, 
but does not know how. Their help must come from 
themselves and will be the result of a long, slow 
process.'* She described the various forms of or- 
ganisation and added: "The last stage of develop- 
ment, that into self-governing associations, has not 
yet come." 

A leader was needed. Who was it to be? There 
were women of commanding personality, great execu- 
tive talent, character, and force, who we e then con- 
spicuous in the German nursing world, but they 
had not large vision. Their interests were provincial. 
The looked-for leader, however, had even then been 
storing heart and mind with evidence of the friend- 
less, helpless state of nurses, and when the opportune 
moment came, she was ready, a woman more forceful 
and able than those already prominent, of executive 
ability superior, and with a sympathy and compre- 
hension that excluded none. 

In 1902, a German magazine devoted to nursing 
interests contained an article by Sister Agnes Karll, 
giving the history f the formation of a modern, 
independent union of nurses, 1 in which she ^aid: 

The need of an organisation for the hundreds of nurses 
who had withdrawn from the existing orders has been 
widely realised in the last few years. At the meeting of 
the National Council of Women, it was first openly 
urged by the widow of Professor Krukenberg, Bonn, and 
agreed to by the two hundred and thirty representatives 
of eighty thousand German women, that nursing should 

1 Die Berufsorganisation der Krankenpflegerin^en Deutschlands: in 
Die Krankenpfiege, vol. ii., part 5, 1902-3, p. 461. 




Sister Agnes Karll 
Founder and President, German Nurses' Association 



The German Free Sisters 9 

be looked upon as a skilled pursuit for women who 
desired industrial freedom, in contradistinction to the 
conservative view that it must either be monopolised 
by religious or charitable bodies or be left to ignorant 
persons. 

Agnes Karll defended energetically the new order 
of free nurses, and said: 

Undeveloped and timid women will do better to re- 
main in the deaconess or Red Cross orders, where they 
never have to think for themselves, but it is useless to 
blind one's self to the rapidly changing conditions of 
to-day ; . . . numberless women who are eager to devote 
themselves to some kind of service to their fellow men 
find the limitations of the deaconess and Red Cross 
sisterhoods too narrow. . . . Above all things we 
wish in our organisation to preserve personal freedom and 
self-government on a rational basis. 

In this article she made clear the nurses' wish for 
three years of training. When the quinquennial 
meeting of the International Council of Women, to 
which the British and American nurses were then 
affiliated, took place in Berlin, in the summer of 
1904, English, Irish, and American nurses assembled 
in that city and there for the first time met Sister 
Agnes Karll, who had been working out her problems 
unaided. Until the winter of 1903, she had not even 
known of the nursing affairs of England or America, 
nor had she been aware that the German movement 
was already being sympathetically watched in those 
countries. To find that fellow- workers of other lands 
were ready and waiting to draw her into an inter- 
national circle whose members all, with interests and 



io A History of Nursing 

aims alike, strengthened one another by moral sup- 
port, sympathy, and encouragement, was a great joy 
and a most unexpected source of help to her. The 
visitors, in their turn, were impressed and stirred 
by the whole -heart edness with which she had dedi- 
cated all her powers to the upbuilding undertaken as 
her life-work. Trained in one of the best Red Cross 
hospitals, with an inheritance that made leadership 
natural, possessed of a far-seeing intellect and keen 
judgment, and with a real passion for bringing help 
to the individual, Sister Agnes lived modestly on a 
small private income and devoted time, strength, and 
brains freely to the service of nurses. 

What she has done so far shall be told in her own 
words: 

The opening of the new century was a turning-point 
in our profession. Numerous occurrences of a painful 
nature, I regret to say, had brought it sharply home to 
the general public that a complete transition from the 
older charitable and religious systems of sick-nursing, to a 
new and secular form, had taken place unnoticed. In 
the course of this silent transition, abuses had been 
permitted to develop which, if not checked, would soon 
drag the noblest and most womanly of all occupations 
in the mire, and yet the new form was the only one which 
could possibly promise to fill the great deficit in the 
numbers of nurses. Two events of the summer of 1901 
had caused especial consternation. One was an actual 
strike declared by nurses: — "Nursing Sisters on Strike," 
said the headlines in the papers; and these, moreover, 
were not the "wild nurses" at all, but deaconesses and 
Sisters of St. John. The daily papers teemed with the 
news, but presently the powerful association of deacon- 
ess Motherhouses found a way to stop the publicity of 



The German Free Sisters n 

details in which the despotism of Matrons had played an 
unlovely part. The other incident was a conflict between 
medical men, when, the victory being to the strong, the 
Sisters, having been arrayed on the weaker side, were 
driven off the field. 

At the moment when the feeling aroused by these 
events was running high, there appeared a pamphlet by 
Sister Elizabeth Storp, called The Social Status of the 
Nurse, which excited keen interest. The numerous ar- 
ticles in the daily press had naturally been characterised 
by complete lack of knowledge of the theme under dis- 
cussion. Much had been written of the motives with 
which nurses took up their work, but little of the actual 
conditions of their lives, and still less of remedies for 
the great hardships they endured. It was, therefore, 
most timely for one of our own number to come forward 
to point out the real difficulties with which nurses had 
to struggle in their calling, such as extreme overwork, 
insufficient pay, and an entire absence of all security 
for the future when old age or ill-health should overtake 
them. It was well, too, for the declaration now to be 
made that these hardships could only be abated by 
"state regulation of training; the general employment 
of trained nurses in institutions and in the municipal 
service; the creation of a free employment bureau for 
them; the establishment of recreation and convalescent 
homes, and above all, the elevation of the status of the 
nurse and her attainment of a higher standard of living. " 
Frau Marie Stritt, then president of the National Council 
of Women of Germany, brought this pamphlet to the 
notice of Augusta Schmidt, of the Allgemeine Deutsche 
Frauen- Verein, the veteran of the Woman Movement in 
Germany, when she came, in the early autumn, to the 
general annual meeting of 1901, and it was then decided 
that the subject of nursing and the state of the nursing 
body should be taken up for consideration at the next 



12 A History of Nursing 

year's Council. To Frau Professor Krukenberg, as the 
widow of a physician, was assigned the responsibility of 
the preliminary work of inquiry into the subject, for the 
dense ignorance of all those present as to the conditions 
of nursing was clearly evident in the discussions. 

Public attention was still further stirred toward the 
end of 1 90 1 and the beginning of 1902, by the publication 
of a pamphlet bringing scandalous accusations against 
the Hamburg hospital, and in the resultant lawsuit un- 
savoury details were aired involving the private nursing 
institutions. Nurses, however, though the ones most 
concerned, took the smallest share in the general dis- 
cussions and showed the least interest, owing, obviously, 
to the shut-in character of their lives and their incessant 
strain under exhausting work. However, in 1902, they 
were stimulated to protest against oppressive conditions 
at the time when the act for the legal protection of the 
Red Cross insignia took effect. Sorely as this act was 
needed to put a stop to the growing misuse by commercial 
establishments of the Red Cross symbol, it yet caused 
real distress to many of the best nurses in independent 
private practice, who had worn the badge in good faith 
for years, believing that they were entitled to it because of 
their training in Red Cross hospitals, their honourable 
reasons for leaving the Motherhouse (often the necessity 
of supporting relatives), and their standing contract to 
serve in time of war. 

A little group of nurses who had come into relation 
with one another through Sister Storp's pamphlet, met 
one day in Berlin to talk over all these things. There were 
Sister Elizabeth Storp, Sister Helene Meyer, Sister Marie 
Cauer, who had written much and admirably in profes- 
sional journals on the conditions of nursing, and I. We 
discussed with great earnestness the coming meeting of 
the Council of Women in October, in Wiesbaden, the at- 
titude they would take in nursing matters, and the de- 



The German Free Sisters 13 

mands they contemplated making upon the government 
for nursing reforms, details in all of which we had been 
asked to give our counsel. The women's suggestions for 
legislation seemed to us not quite desirable, and to me, 
especially, with my ten year's experience of private duty, 
their ideas of state control of private nurses seemed im- 
practicable. My colleagues, whose lives had been spent 
in hospital work, laid the chief emphasis upon hospital 
reform, and one and all planned to go to Wiesbaden to 
take part in the proceedings. 

I alone was not satisfied, for the prospect of future 
reforms in hospitals gave no promise of help for the 
hundreds of nurses who were now and had been for years 
making the hard struggle for existence in the lonely 
isolation of private duty. It was clear to me that they 
must unite ; clear, too, that this union must be outside of 
the hospitals ; yet to form independent associations was a 
thing unheard of for German nurses. While I hesitated, 
the correspondence over the proposed resolutions went 
on, and at last Frau Krukenberg wrote : — ' ' The only prac- 
tical remedy for all abuses is self-organisation." This 
declaration made me also decide to go to Wiesbaden. 

I had long hung all my hopes for improvement in nurs- 
ing conditions on the Woman Movement. Like all nurses 
in private practice, I had had little time to form new re- 
lationships, but through friends I had been kept supplied 
with the literature of the movement, and during my ten 
years of private duty, and before that in several years of 
varied experience with hospital work, I had given my 
spare time to a thorough study of all that the Woman 
Movement implied and included. Then a fortunate acci- 
dent, or let us say a dispensation, had put me in the way 
of discovering the only road then leading to a provision 
for the future of our nurses: namely, the annuity and in- 
validity pension arrangement of the German Anchor Life 
Insurance Society. When my long overtaxed strength 



14 A History of Nursing 

finally failed so far as to compel me, in 1901, to give up 
nursing, I had devoted myself to a careful study of the 
possibilities of private and government insurance, gaining 
also, in the course of this inquiry, a personal knowledge of 
the nurses' homes in Berlin. Thes 3 homes, while rapidly 
increasing in numbers, were fast acquiring a very unde- 
sirable reputation, and it was the experiences of this 
year that gave me courage and perseverance to take the 
helm when the time came. 

The meeting took place. It was a glorious autumn 
day as we four entered Wiesbaden. How I wish that 
every Sister might have been there with us for just 
that one session, when, for the first time, a vast throng 
of women, the representatives of 80,000 members of 
the federated women's societies, took up the conditions 
of the nursing profession for discussion! Hitherto the 
public and the press had held it to be a desecration 
to practice nursing as a means of livelihood. Here, on 
the contrary, it was regarded as self-evident that this 
was one of the most natural of self-supporting occupa- 
tions for women, and that, without need of a religious 
background, it might be built up on solid founda- 
tions with thorough training and sensible conditions of 
living. Augusta Schmidt was dead, but many other 
veterans of the Woman's Movement greeted us with the 
warmest kindliness, and I felt certain that this was the 
only direction in which we might look for energetic help ; 
equally certain that we must unite among ourselves at the 
earliest possible moment. Fraulein von Wallmenich, 
from the Red Cross hospital in Munich, was on the 
programme, and, naturally, took the position — " Nursing, 
uncontrolled by Motherhouses, is impossible. " Motions 
were made by Frau Krukenberg and Frau Eichholz, and 
were supported, but were finally withdrawn in favour of 
one framed by our group, in some parts of which we had 
had the collaboration of Professor Zimmer. 



The German Free Sisters 15 

It was as follows: — "The Council of Women shall 
present a memorial to the proper officers of the govern- 
ment, containing a petition covering the following points : 
It should be the duty of the State : — 

" (1) To define a three years' training for nurses that 
shall be recognised by the state; to admit nurses having 
passed through such a course to a state examination, 
and to bestow upon all successful applicants a state 
certificate and a legally protected badge which may be 
removed by the proper authorities for sufficient cause. 

"(2) Only those hospitals shall be recognised as can 
show a proper care for their nurses through the limitation 
of working hours to eleven daily, and through a sufficient 
provision for their staff in old age and invalidity, the 
state to set an example of a model nursing organisation 
which shall give due balance to the administrative, 
medical, and nursing spheres, and secure the moral and 
material interests of the nursing staff. " 

After Fraulein von Wallmenich, Sister Marie Cauer 
and Professor Zimmer spoke, and the resolution was then 
unanimously adopted without amendment. To-day a 
small part of our demand has been realised, and we need 
not despair of gaining the rest in the course of time, if we 
do our duty. 

Many precious relationships are woven in with those 
days in Wiesbaden, and many good friends were gained 
for our cause : I need only mention Frau Poensgen, Frau 
Krukenberg, Frau Cauer, and Oberst Galli. 

Only Berlin would do, of course, as the centre of our 
new organisation, for besides being the seat of govern- 
ment it was the home of by far the largest number of 
nurses. Immediately upon my return I began taking 
steps to carry out our plans. It seemed to me impossible 
to undertake such a responsible business venture without 
the advice of men, and so I tried to secure Herr Geh. 
Sanitats Rath Aschenborn and Herr Oberst Galli as 



16 A History of Nursing 

president and treasurer. Already warmly interested 
in our cause through Sister Helene Meyer, Herr Geh. 
Rath Aschenborn helped me willingly to frame the by- 
laws which, with a few additions, are in force to-day, but 
he advised me emphatically to have no one but nurses 
upon the governing board; for, he said, "The members 
of a profession are the only ones who can judge correctly 
in the affairs of their profession." And Oberst Galli, 
on grounds of health, could offer us no fixed services, but 
gave us the first hundred marks for our treasury. We 
soon succeeded in finding the women needed as organising 
members for the new society. Sister Clara Weidemann, 
Sister Anna Wundsch, Frau Dr. Metzger, and Fraulein 
Heydel promised to help me, and on January II, 1903, we 
called a meeting in the Emmaus Sisters' Home to found 
the German Nurses' Association. To our delight and 
surprise thirty-seven Sisters, all of whom showed intense 
and ready interest, answered the call. Yet doubts as to 
the possibility of success were inevitable, and another 
meeting was proposed. I objected — "Now or never!" 
and carried the day. The by-laws were read a second 
time and adopted by twenty-eight of those present. 
The next day two more nurses entered, so that we had a 
membership list of thirty to take to the chief of police 
with our announcement. 

To send the necessary notification of our organisation 
to the proper department of the government was our 
first public step. To-day none of our many members 
dreams of the trembling fear, the anxious deliberation, 
with which we few women ventured into this, to us, so 
absolutely unknown a region. Limited means, no assist- 
ants, no experience. The by-laws had to be sent in 
duplicate with the notification. Who wrote the clearest 
hand? Sister Fanny Kraft met this demand successfully. 
Next came the notification to the Amtsgericht, the 
local bureau. The first attempt was vain. All five 



The German Free Sisters 17 

members of the executive committee and officers of the 
association must appear before the court at a certain 
hour in the morning. After a thorough scrutiny of our 
by-laws, it appeared that we could not obtain a simple 
association charter, as in our contemplated office and 
registry we were regarded as conducting a business. We 
were advised to seek a corporation charter, and this was 
even more satisfactory to us, as it gave us more important 
standing. That it took longer did not matter, but it did 
much matter that we should be released from the neces- 
sity of having all the officers appear at a particular time 
and place in the huge city, every time there was a change 
of officers or an amendment to the by-laws. This detail, 
hard enough for business men to meet, would have been 
simply impossible for us. 

Our first bow in public having been thus successfully 
made, we hastened to increase our membership. The 
friendly precincts of "Emmaus" still, as at first, gave us 
a meeting place. The presidency was entrusted to me; 
Fraulein Heydel undertook the secretaryship and vice- 
presidency, for none of us had ever kept minutes, far less 
conducted a meeting. Sister Clara Weidemann, Frau 
Metzger, and Sister Anna Wundsch filled the rest of the 
offices. No one had time to work outside of the hours 
of meetings. All that I could not do myself I must find 
volunteer help for. A temporary office with registry was 
developed in the tiny flat where I lived with four nurses. 
Sister Marie Stangen, whose health did not permit any 
longer of private duty, and who kept house for us, was 
always ready to help. Several Sisters offered to help 
when off duty. Then there was a lively coming and 
going, telephoning and general activity. Writing could 
only be done after ten o'clock at night. A group of 
nurses in other places had already become linked with 
our little home through the years of past work. Here 
was the nucleus for our employment agency. Lists of 

VOL. IV. — 2 



18 A History of Nursing 

addresses were put up, invitations sent broadcast to 
interested friends, hectographing, enveloping, addressing* 
stamping was to be done by the hundred. The work was 
arduous, but what delight we took in this first co-opera- 
tive work for a great end ! 

On January 29th we held our first public meeting in 
the assembly room of the Girls' High School in Burg- 
grafen Street. It was most kindly placed at our disposal 
by the Principal, and we only had to rent the chairs. Our 
audience had been invited by cards and notices in the 
daily papers. The president of a woman teachers' 
association remarked after this meeting that ' ' one could 
easily distinguish the Sisters from the rest of the audience 
by their expressions. A veil of weariness seemed to 
cloud their faces. One could see that they had no time 
to adjust their minds to new ideas." I cannot describe 
the embarrassment with which I began my first public 
address on nursing conditions and our aspirations. Only 
two doctors came — Professor Salzwedel and Dr. Jacob- 
sohn. The former was instructor at Charity, where 
a three months' course in nursing was conducted. At 
that time, it was the only public course under govern- 
mental auspices for training in nursing. It was open to 
everyone, men and women alike, upon payment of a 
moderate fee, and was terminated by a state examination 
Dr. Jacobsohn was the editor of the Deutsche Kranken- 
pflege Zeitung. In the discussion he, supported by Pro- 
fessor Salzwedel, took the position that if we regarded 
our calling as a profession, we should give up the title of 
Sister, as to retain it was only going half-way. Though 
none of us agreed with him, we were not prepared to 
refute his argument, but Fraulein Hey del deftly came to 
the rescue, declaring that the professional nurse was now 
forming a sisterhood, and would do wisely in retaining 
this name, so intimately interwoven with the life of the 
people. The president then laid emphasis on the point 



The German Free Sisters 19 

that only through sisterly union could our aims be 
reached. Thus the professional idea and that of sister- 
hood were united in the outset of our career, even if 
not as firmly as they must be in the future. 

This meeting brought us many new members, as did 
also our next on February 28th in the Victoria Ly- 
ceum, when Frau Krukenberg spoke on "Professional 
Organisation for Nurses." Work also increased, as 
testimonials and endorsements had to be verified, and 
Sister Eugenia von Raussendorfl offered her services. 
Now also came the first one of the many official journeys 
of the president, and the membership list grew so fast 
that it was no longer possible to carry on the registry 
work in our little dwelling, where nurses on private cases 
for night duty often came home to sleep. So after 
careful deliberation we made the plunge and rented the 
first office in the garden house at Bayreuther Street, 
Sister Eugenia having promised to rent two of the rooms 
and to act as registrar. It was a serious question to be 
responsible for the rent, the telephone, salaries, and 
furnishings. Many were the knotty points to be decided. 
Our by-laws with a letter were sent to all the 2400 physi- 
cians in Berlin, and Sister Kathe Angermeyer and Sister 
Elf ride Bettenstaedt helped with the ever greater task of 
addressing and mailing. Such an extraordinary amount 
of mail matter fell into the division post-office that they 
looked darkly at us there, and we divided our mail be- 
tween several districts. 

In March, at the annual meeting a sort of court of 
appeals was chosen, and two Sisters who had taken 
business training were appointed as auditors. Many 
other things were dealt with at that meeting. It was 
moved to attempt some approach to the Red Cross 
Society, and we applied to them for the use of their 
emblem for our badge; then there was the eligibility 
for war service to work for, especially with a view to 



20 A History of Nursing 

the claim for post-graduate courses in hospitals, which 
we wished to press energetically, knowing well how 
many gaps there were in our training; the question of 
reduced railroad rates for the Sisters and the granting 
of a charter had also to be considered, countless visits 
made, and preparatory work done for all these various 
memorials. What we would have done without our 
most loyal of all friends, Herr Rittmeister Praetorius and 
his wife, it is impossible to imagine. He, as member of 
the Reichstag and the Prussian Diet, could always advise, 
drill us unsophisticated Sisters in the forms, ceremonies, 
and proper use of titles in addressing the various official 
bodies, and show us how to go about managing our affairs. 
But all our memorials were at first fruitless, with the 
exception of the reduced railroad rates. In 1903, after a 
searching and favourable scrutiny of our nurses' district 
work with the poor, this, to our great satisfaction, was 
granted. 

The correspondence had now assumed such dimensions 
that a second Sister was installed in the office in August, 
1903. Shall we ever again feel such fascination and 
exhilaration as in those early days? Shall we ever greet 
even the greatest success, attained with difficulty, as all 
must be, with such rejoicing as we felt then over the 
smallest steps forward? In that little circle it was 
possible to come into close contact with each; the cor- 
respondence with the distant Sisters could be personally 
and intimately carried on; one could share the needs and 
the cares, great and small, of each one in a way that now 
with the many hundreds, is impossible, greatly as one 
longs to do it, for the day has only so many hours and 
strength has its limitations; and that some feel grieved 
when they return, remembering the old times, now to 
find new faces and a great pressure of business absorbing 
every one, we who went through the first days under- 
stand very well. But patience! The individual will 



The German Free Sisters 21 

come to her own again when we have our local groups 
built up in every part of Germany, each with a nurse at 
its head who will be indeed a warm-hearted sister to every 
member. In July, 1903, our first local affiliated group, 
under the leadership of Sister Christine Esser, joined us. 
It was a private institution of Frankfort. So well has it 
thriven that in March, 1908, its members owned their 
headquarters. Next the founder of a group in Stuttgart 
desired to get into touch with us, and I made the first 
visit to Frankfort and Stuttgart at the same time to get 
acquainted with the nurses, among them Sister Martha 
Oesterlen who, we had learned at Wiesbaden, was in 
sympathy with us. . . . As it means much personal 
sacrifice to develop such centres, it is not to be wondered 
at that they have not multiplied more rapidly. First 
the Sisters in a locality must be gathered together, then 
some one who must necessarily be a nurse must be found 
who will stimulate wider growth and assume the leader- 
ship. Although it is essential that the governing board 
of the central organisation shall be limited strictly to 
nurses by the necessity of keeping the general manage- 
ment in the hands of members of the profession, the local 
branches may be differently managed. There, I have 
been desirous of gaining the co-operation of women who 
were interested in the progress of women from the broad 
standpoint. In the local groups we shall welcome the 
co-operation of physicians and lay women on our boards 
of officers, provided always, of course, that they sympa- 
thise intelligently with our ideals of professional develop- 
ment. But the many ' ' bad examples ' ' both at home and 
abroad must ever prevent us from falling back into that 
indifference which tends to let the control of our work 
drop out of our hands because it is easier not to take 
responsibility. 

There is no such thing as independence without re- 
sponsibility. We must never forget this; and every 



22 A History of Nursing 

member must realise her duty of responsibility to our 
own association, which we ourselves have called into 
being. Only the harmonious working of all parts in 
unity can ensure its fullest usefulness for the benefit of all 
its members. Again, though every organisation has the 
right and even the duty of refusing the membership of 
the unworthy or the undesirable, yet its aim should not 
be to limit itself solely to a small select circle, but to 
include the greatest possible number of the average 
people, giving them that support which they, even more 
than others, need, not only in business and in professional 
interests, but still more in human brotherhood. 

In every other profession than ours a standard of 
efficiency has been developed, whilst in nursing, so long 
as this was monopolised by religious and charitable 
bodies, the importance of professional knowledge was 
often quite overlooked and religious motives and duties 
were given front place, naturally resulting in collisions 
with the claims of science and hygiene. As necessity, 
during the last few decades, gradually imprinted upon 
nursing the stamp of a self-supporting occupation for 
women, it was inevitable that in the absence of an 
accepted professional standard improprieties of the most 
deplorable kind should occur, such as the incidents which 
first called our association into being and, next, compelled 
the government to take precautionary measures. 

Above all must we strive for this — that with the im- 
proved technical education we shall never, in time to 
come, lose that which is most needful in our calling and 
which can only be imperfectly defined by law, namely, 
an enriched ethical ideal. This we need everywhere, but 
most urgently upon the battlefield of the social misery 
of our times. This gives the trumpet-call to all noble 
natures, men or women, among our people, and we, who 
by virtue of our calling should be first to respond, are the 
most poorly armed for the fight, because, in our hospitals- 



The German Free Sisters 23 

we have been drilled simply in the technical side of 
nursing without being given sufficient comprehension of 
the claims of humanity. This is the reason why, for 
such positions as that of Sister in the women's venereal 
wards of a large city hospital, one seeks almost in vain 
for suitably prepared women who are ready to assume the 
most difficult, yet most sacred tasks of our calling. For 
there it is not only a question of caring for the body, but 
of finding the lost soul; there it is a question of taking 
the sins of the whole world upon our shoulders; such 
work calls not only for special qualities, but also special 
training and preparation, as not everyone can be an 
original genius and succeed in creating professional 
standards. 

Only the hospitals can lay the foundations for our 
calling. It was therefore naturally of the greatest 
importance that we should cultivate relations with them. 
The increasing shortage in the numbers of nurses was 
the usual starting-point of negotiations between us, which 
were often broken off by mistrust of our form of organisa- 
tion. The City hospital in Frankfort- a- M. took our 
probationers willingly from 1904 until 1907, when it 
suddenly forbade its accepted pupils to remain members 
of our society. Their reasons for this step are hardly 
clear, for no hospital needs to fear our self-government, 
or to suspect that we shall remove probationers or Sisters 
from its service, a thing we would not do even if we could. 
We are at all times the best champions of the hospitals, 
as their interests are identical with ours. We did oppose 
the custom of binding probationers by a money deposit, 
for this custom is either useless or harmful. However, in 
the matter of the two- or three- years' contract, we agree 
with the hospitals only if they extend their plain duty of 
teaching over the entire time of the nurses' service. 
This would be, moreover, the best solution of one of the 
greatest difficulties, namely, the overburdening of both 



24 A History of Nursing 

hospital and pupil in the attempt to give the whole 
training in one year's time. x 

The rapid growth and pressing activities of the 
young society soon brought the need of a professional 
organ to the front. Sister Agnes wrote: 

In the summer of 1905, we decided on the bold step 
of starting our own paper in January, 1906, and as early 
as October, 1905, we found it necessary to begin with a 
small printed pamphlet, Mitteilungen an unsere Schwes- 
tern, which may really be regarded as our beginning. 
Only those who have themselves founded a paper know 
what a progressive step it is for a society to have its own 
organ, but they also alone can know what work, anxiety, 
and responsibility it means for the editor. One thing is 
certain, such a paper can only be of real use to nurses and 
can only develop on true lines when controlled by mem- 
bers of the profession. Now nursing in Germany is not 
a good school for public work. Owing to the religious 
origin of her work, a nurse still seems, and in many cases 
is encouraged to be, a person apart from daily social 
interests! How much there is for her to learn, if in 
connection with all her other duties she decides to run a 
paper! . . . 

We exchange journals with all professional and women's 
papers, we also send it gratis to all women's clubs at 
home, to some abroad, and to all Information Bureaus, in 
all sixty-one. These are only small numbers as yet, but 
we are beginners and have had so short a time to develop 
that we have but little to offer when we compare ourselve? 
to our "Sister-press" in other countries. Still, we began 
with nothing; what we have succeeded in doing has been 
done with our own means and by our own strength in the 

1 Unterm Lazaruskreuz, January 15, 1908, and succeeding numbers; 
articles on "The History of the Association," by Sister Agnes Karll. 



The German Free Sisters 25 

struggle for independence and progress, and we can only 
say that we are content with the results. Even now, in 
our second year, we are able to print a double number 
when necessary, and numberless copies find their way 
from time to time to distant lands, winning for us new 
friends. . . . x 

The official nursing journal, of course, needed a 
name, and a symbol. The name Unterm Lazarus- 
kreuz was chosen, as, in 1904, after consultation with 
artists and antiquarians, a badge of the extinct Order 
of St. Lazarus had been adopted as the society's 
emblem. Sister Agnes explained the reason for this 
selection as based upon the social service of the 
combatants of leprosy, and said: 

Perhaps it may seem strange to many that in spite of 
our calling ourselves "interconfessional" we have chosen 
a cross for the badge of our journal and association. It is 
an historical fact that owing to nursing being, so to say, 
the offspring of the Church, the cross is her natural coat- 
of-arms. Not the so-called "Red Cross" — that of the 
Geneva Convention, which, out of gratitude for the initia- 
tive given by Switzerland, adopted its coat-of-arms in re- 
versed colours for army nursing — but a much older cross, 
as displayed by the Order of St. John and the Knights of 
Malta. Such an old historical cross is the one we have 
chosen, a relic of the Crusades, worn by a knightly order, 
now extinct, in their fearful social struggle against leprosy. 
And as we also are at war with social abuse, sickness, 
and sorrow, we consider we may claim the right to follow 
the advice of an artist and reanimate this symbol of olden 
times as the seal and badge of our earnest endeavours. 

1 Reports of the Paris Conference, IQ07. Papers on "The Nursing 
Press." 



26 A History of Nursing 

It is our earnest wish that our badge be thus worn, that 
each issue of our journal shall carry into the world the 
true meaning of our efforts. Our motto needs no explan- 
ation. Ich dien speaks for itself, and when one thinks 
of the many difficulties we have surmounted and of the 
still greater number before us, the encouraging words of 
our second motto, per aspera ad astra, will not be con- 
sidered out of place. 

Before the association had finally adopted this 
badge, their use of it was contested by the Red Cross 
societies upon the ground that it resembled the 
Geneva Cross. It is, however, quite different. 

Young as we were, it seemed to us of the most far- 
reaching importance that, in January, 1905, the city of 
Dusseldorf made overtures to our society to staff its new 
hospital when finished. It was expected it would be 
opened in October, 1906. Professor Witzel of Bonn was 
chosen as Director, and my first interview with him, his 
medical chief, and the city officials concerned, was held 
in Dusseldorf in 1905. . . . The course of training was to 
last for two years, instead of the one recognised by the 
law. [The two years' course was later abandoned for 
one year.] The four weeks' service required of the 
Sisters who were to take posts at Dusseldorf, given at the 
Friedrich Wilhelm Stift in Bonn, was a valuable service 
for our members and gave gratifying evidence that it 
was entirely possible for them to work in complete har- 
mony with the Kaiserswerth deaconesses there. . . . 
That all did not come to be realised as we had hoped in re- 
gard to Dusseldorf is well known to all our Sisters. Nor 
would it be easy to say where the fault lay. We are in 
a transition period which is characterised by special 
difficulties in all our hospitals. There is hardly any 
German hospital where the conditions to-day are satis- 



The German Free Sisters 27 

factory or promising, and things are naturally at the 
worst in the vast city hospitals, with their complex 
management. As the same theme with variations is 
found everywhere, it is clear that the root of the trouble 
lies in the system — in the mode of organisation of hos- 
pital work. To trace it to the point of clear demonstra- 
tion of where the trouble lay, why general discontent 
and continuous change are the rule, would be the first 
step toward improvement. To us, it is of first import- 
ance to know in how far the Sisters are at fault. . . . 

We should not only be nurses for the sick, doing simply 
what is necessary for the physical care of our patients, as, 
in the mad race of work in a big hospital, with its under- 
staffing, is often unavoidable, but we must be apostles of 
hygiene of social progress, if we wish to fill a place in the 
life of the people. We are only useful for a few years in 
hospital or private duty, while we are in the prime of our 
strength. And then? Then our future is in social work, 
whose full possibilities are only now beginning to be 
recognised. True, we have not been prepared for it . . . 
we must see to it that we are prepared. r 

The year 1907 brought many important events: 
The corporation charter was granted; the suit 
brought by the Red Cross against the organisation 
to prevent its adoption of the Lazarus-Kreuz as a 
badge, on the plea that it might be mistaken for 
the Geneva Cross, was decided in favour of the 
German Nurses' Association. Then came June 1st, 
when the Imperial Registration Act for Germany, 
first demanded by the nurses at the Wiesbaden 

e ■ Unterm Lazaruskreuz, articles on "The History of the Associa- 
tion," by Sister Agnes Karll, in January 15, 1908, and succeeding 
numbers. 



28 A History of Nursing 

meeting of the Council of Women, in 1902, went 
into effect. 

In March, 1905, the Federal Council had ac- 
cepted the draft of an act regulating the practice 
of nursing for the German Empire. On March 
2 3» I 9°7» a conference of nursing associations with 
the Minister of Education, von Studt, was called 
together, and on June 1st, of the same year, the act 
went into effect in Prussia. The law, as adopted, 
did not fully meet the nurses* wishes, but they re- 
garded it as a step in the right direction. For 
one thing, the state formally recognised nursing 
as a professional career, and thus a weapon was af- 
forded against the worst of those abuses which had 
grown up under unrestricted competition. There 
would now be a line of distinction drawn between 
nurses who had passed a state examination and those 
who had simply been "examined by a physician." 
If the public had realised what was implied in this 
latter ceremony it would have been less easy for people 
to be deceived as to the respective merits of nurses. 
Such examinations might even be based upon a six 
weeks' lecture-course given in an office, upon pay- 
ment of a five-dollar fee, and certificates signed by the 
physician-lecturer gave the holder the right to nurse 
the sick ! No wonder that the public sometimes saw 
the resorts of such persons closed by the police! The 
German registration act requires one year of study 
and hospital training, and though this is too short, 
it will act in a salutary way upon the present six 
months' courses. Examinations are held twice a 
year in hospitals, and comprise oral and written 
tests, with practical work under observation in the 



The German Free Sisters 29 

wards. The examining board is composed of three 
physicians. Eleven subjects are specified for ex- 
amination. The examination is not compulsory, but 
calls for one year's work and study in a public 
hospital or in one recognised by the state. 1 
Sister Agnes wrote of the passage of the act : 

That will remain for all time one of the most memorable 
days in German nursing, because on that day the nurses' 
calling was stamped and sealed as a secular profession. 
Much as there still remains to do, nevertheless this first 
legislative act in protection of our work, incomplete as we 
hold it to be, has erected a new foundation upon which we 
may and must build to completion. 2 

The conference called by the Minister of Education 
to discuss the scope and details of the law, and held 
on March 23d, was a noteworthy occasion. All the 
nursing bodies of Germany sent their representatives. 
Catholic orders and deaconess Motherhouses, Red 
Cross societies and the Diakonie Verein, city hos- 
pitals and the German Nurses' Association, — all were 
there, but out of thirty-one such delegates only six 
were women. Sister Agnes said: "The conference 
was a step of the greatest importance. It was char- 
acteristic that, while all the other nursing associa- 
tions present were represented entirely, or largely, 
by men, we alone, an independent body of women, 
were distinguished by having our elected president 
there to act for us." [Sister Agnes herself.] 

1 Abstract of paper read by Sister Charlotte von Cammerer at 
the Paris Conference, 1907, on " The German State Registration 
Act for Nurses." 

3 Unterm Lazaruskreuz, April 1, 1908. 



30 A History of Nursing 

The act, it will be remembered, is not compulsory, 
and the deaconess and Red Cross Motherhouses were 
extremely reluctant to accept it. The Catholic nurs- 
ing orders received it with the best grace, and, whether 
they liked it better or not, were among the first to 
agree to conform to its requirements for professional 
instruction. 

From now on the friendly alliance with the army 
of the Woman Movement became continually a closer 
one. 

Sister Agnes wrote: "Our connection with the 
Woman Movement has developed in a gratifying 
way, and has been fruitful in its broad relationships." 
That summer she spoke on organisation among nurses 
at meetings of the Council of Bavarian Women, and 
on proper training at the public evening meeting of 
the National Council of Women in Jena. In the 
autumn and winter came invitations to speak on 
nursing and its problems in many parts of Germany. 
Into those years of strenuous labour we will now look 
for a moment through the medium of Sister Agnes's 
letters : 

1906. 
. . . But I am not well — always ailing, and have to 
be very careful ... In our office they are working like 
slaves; it is too bad and I do not know how it is to end. 

Sister often looks so ill, I am afraid she will break 

down. . . . We now have a very nice new Sister for the 
telephone and office work. . . . But we need one more 
and have not the money or the right person to do it. . . . 

Not long ago I went to see for the first time since 

January. It is amusing to see how evident it is that we 
are gaining ground. He was always nice, but this time 



The German Free Sisters 31 

he was as proud as a peacock, because he had always 
known that we would make our way. He told me that 
the German registration act was really our work, and 
that we were his best hope. . . . 

Life is rather hard sometimes, but nothing of all the 
worry can be everlasting, and so it is not worth while 
to take it too hard. I am very glad of the few drops 
of old wendischem Fiirstenblut in my veins which never 
let me lose my courage. . . . 

My tour through west and south Germany was 
dreadfully fatiguing but inspiring, and those five weeks 
seem like years. Is it not nice that the Munich doctors 
asked me to speak before them? And they took my 
reproofs so well : I do not think doctors quite as hopeless 
as I did. 

Saturday I have to go to a little town one hour distant 
to look after one of our Sisters, who tried to take her life, 
because she feels that she will not be able to work much 
longer. It is heartrending, but the doctor wrote me 
some splendid letters — he feared we would expel her — 
every Motherhouse would do so. . . . 

A young doctor came to see me a week ago — a fine 
fellow ; he is a member of our association, and I asked him 
if he would take the poor girl for his little eye-clinic and 
he promised at once that he would. But first she must 
go for treatment — God may help us to save her. I am 
so sure we will find the means to make the way easier for 
all these poor overworked girls, and in time we will find 
them a convalescent home. Life is a dreadful thing, 
but it is fine to grapple with it and get the better of it. 
I sometimes feel like little David with the giant Goliath, 
but I think in this battle a warm heart is the only stone 
to throw. . . . 



32 A History of Nursing 

I am in bed for a little rest, so I have a quiet hour after 
sending some notices to the papers about our battles won. 

Geh. Rath in the Department of Education told me 

to send them, and I think it is a good thing to do. Some 
of them always take our slips, and I hope to find a million- 
aire for another legacy. 

In April I have to speak at the Bavarian Women's 
meeting about nursing ; in May I must go to a committee 
meeting of the National Council of Women to which I 
belong ; in June, Paris — so you see my life is full to the 
brim. I had a good fight one evening not long ago with 
all my dear enemies in the Society of Social Medicine, 
Hygiene, and Medical Statistics — a discussion of Dr. 
Eugen Israels' paper on our registration act. . . . The 
fight will really only begin in the next few years. This 
was only a little taste of it. 

The comedy about our badge before the Schoffcnge- 
richt is just finished. 

1908. 

How I would like you to see our offices now, with 
ten salaried Sisters in them, and so many new inventions 
and things! 

My tour of lecturing was full of interest and pain. I 
saw heaps of authorities, and so many nurses. I think 
I never before realised as I did this time how sorely 
they need us. We can do a good deal for them, but 
alas! never enough. And how they die; that is sim- 
ply heartrending! So many suicides! And so many 
dreadfully ill, and most of them die too young! . . . L 
had a strenuous time, four weeks in eleven places; — not 
more than five or six hours' sleep and working hard all 
the rest of the time — lectures and visits. 

By 191 1 the association had federated branches 




o 5 



The German Free Sisters 33 

in Hamburg, Bremen, Baden, Wurttemberg, Saxony, 
a group centre in Riga, Russia, including German 
nurses all over Russia who are members of the 
German Nurses' Association, and in Frankfort. 
The groups are largely self-governing, and form 
nuclei for the furthering of local interests and 
the study of local needs. So steadily grow the 
affiliated societies that detail must not here be 
attempted. 

The modern era is in full swing in Germany. The 
rush to great cities is steady, industrialism has 
marshalled its problems, and the free Sisters are 
responding to the call for the many specialised forms 
of social service. District nursing, in its older form, 
is still in the hands of the Church, but the newer 
lines of preventive visiting nursing are being directed 
by the municipalities, and nurses are being appointed 
to give instructive care to the families of tuberculosis 
cases, especially of those sent to the sanatoria main- 
tained by the government insurance; to follow up 
alcoholic cases and their families, and to watch over 
the well-being of infants. By 19 10, fifteen German 
cities had appointed women, many of whom are 
trained nurses, as police-assistants. Their duties 
call for the finest combination of womanly initiative 
and professional tact and skill. In the vast need for 
many such assistants is a suggestion of the new paths 
opening before the modern German nurse. School 
nursing, first established in Chariot tenburg, was still, 
in 191 1, in its very early stage of development. In 
two h gh schools for girls in Chariot tenburg, nurses 
were teaching hygiene, simple nursing, and the care 
of infants. Many district nurses, epecially those of 

"OU IV. — 3 



34 A History of Nursing 

the Diakonie Verein, gave similar courses. Nurses 
were giving talks and demonstrations on nursing in 
the home in girls' boarding schools, to classes of 
wives and mothers of well-to-do families, and to 
groups of factory girls. There were a few employed 
in factories and department stores to guard the health 
of employ es, and a few in the employ of hotels and 
ocean steamers. On the whole, Germany had not, 
at the time this was written, utilised nurses in pre- 
ventive work as fully as she might have done. 

Among the nurses who have entered actively into 
fields of social reform none has stirred up more active 
controversy than Sister Henriette Arendt, who is 
known as the first woman in Germany to hold the 
position of Polizeiassistentin. A woman of rare sym- 
pathy, fearlessness, and energy, she has been described 
as one of the most striking figures of the modern wo- 
man movement. For a number of years at her post in 
Stuttgart, her vigorous altruism flew far beyond her 
prescribed duties, and voluntarily, in her free time, 
she followed trails which unearthed obscure forms of 
cruelty to and mistreatment of children. The socie- 
ties existing for the protection of children took offence 
at her revelations, and when she made public her 
proofs that there was a genuine slave trade in children 
for immoral purposes which yearly swallowed up 
hundreds of little girls (usually illegitimate waifs), 
and that police departments and charitable societies 
were alike silent in its midst, bureaucratic dignity 
was outraged. She was officially ordered to cease 
her extra-official work. This was impossible to a 
woman of her temperament and impatience with slow, 
moderate ways of dealing with wrong, and her criti- 



The German Free Sisters 35 

cisms provoked counter personal criticism and 
recrimination. In the resulting clash of dispute, 
Sister Henriette resigned in order to devote herself 
wholly to the salvation of the children in whose cause 
she had enlisted, and undertook to support herself 
by lecturing and writing on her subject, making her- 
self, meantime, responsible for several hundred 
rescued children. (By 19 12, over 1200.) 

A striking and picturesque accompaniment of the 
new movement in nursing is the wonderful growth 
of hospitals. Like magic, new hospitals of the most 
remarkable beauty are springing up in or near Ger- 
man cities, built like village colonies in parks and 
gardens, of immense extent, able to care for thousands 
of patients, of the most highly perfected details of 
architectural charm and fitness, meeting scientific 
demands for treatment, speaking the last word in 
inventions, apparatus, and labour-saving machinery, 
and, withal, showing a captivating attractiveness of 
ward interiors, bringing the whole force of combined 
beauty and usefulness to bear on the problem of 
treatment. These new hospitals will require hun- 
dreds of women, trained to the highest standards of 
the nursing art, to staff them properly. Great 
changes are already going on in them. An item in 
one of the daily papers for 1906 said of the Charite, 
which has been largely remodeled : 

A number of the Kaiserswerth deaconesses were re- 
called last year, and this year the rest have gone. The 
Sisters from the Clementina House in Hanover were the 
next to go. All the posts are now filled with Charite* 
Sisters. The nursing is now unified [but with no nurs- 
ing head!], and is directly under the control of the direc- 



36 A History of Nursing 

tors of the hospital, instead of being, as before, carried 
on by nurses from different institutions, each group 
being under the control of its own school. 

So moves the world ; but one must offer the tribute 
of a feeling of sadness to see the Kaiserswerth deacon- 
esses leaving old Charite, where Mother Fliedner 
brought them long ago on her wedding trip. The 
hospital directors first tried an entire permanent 
staff; then, with ward Sisters, opened a training 
school. The educational standard complies with the 
registration act, but the school is not a model. Charite 
is distinct among German hospitals by its refusal to 
have a woman superintendent of nursing. 

The most pressing problem to be worked out in 
these splendid new institutions is that of the proper 
organisation of the department of nursing. At 
present there is, in some quarters, chiefly among the 
authorities and their subordinate officials, a distinct 
unwillingness to give this department its proportion- 
ate share of importance and administrative power. 
Though, with the exception of Charite, the hospitals 
appoint Matrons, they do not give them their right- 
ful position, nor do they secure for them a training 
and experience which will enable them always to 
handle and develop their work as Sister Helene 
Meyer has been able, at Dortmund, to do. 

The most serious individual problem facing the 
German nurse is, without a doubt, that of overwork. 
The saying sometimes heard, whose origin no one 
knows, that a nurse's working life is ten years, must 
have originated in central Europe. In 1903, Alfred 
von Lindheim, a member of the Austrian Parliament, 
published a book called Saluti JEgrorum: Aufgabe 






The German Free Sisters 37 

und Bedeutung der Krankenpflege im modernen Staat. 
In this he studies statistically the morbidity and 
mortality of nurses, finding the death-rate among 
them to be twice as high in Germany and Austria as 
that among other women of corresponding ages. 
Analysing his figures, he finds the highest mortality 
among the Catholic Sisters of Mercy. Some of these 
orders have from seventy to one hundred per cent, 
of deaths from tuberculosis. Taking all the Catholic 
nursing orders in the German-speaking countries 
together, he finds their average death-rate from tu- 
berculosis to be sixty-three per cent. As youth is 
susceptible to overwork and infection, the mortality 
is so much greater in proportion as the Sisters are 
younger, and he states that nearly all the Catholic 
Sisters included in his inquiry died before they were 
fifty years of age (p. 165). He found the tables of 
sickness and disability astounding. For every one 
hundred Catholic Sisters the time lost through illness 
in one year amounted to something over 585 days 
(p. 178). He found the morbidity and mortality 
among deaconesses, Red Cross, and other secular 
nurses to be considerably less, yet, as many such 
women leave their orders, he considered that they 
were lost to statistical research and that, if they 
could be found, the actual percentage might be 
greater than his results. He gives four explanations 
of the high morbidity and mortality figures of the 
religious orders: 

(1) Probationers are taken too young, and physical 
examinations are not rigid enough; they are often 
admitted with inherited disease or delicate physiques. 
His conclusion is that, solely on physiological 



38 A History of Nursing 

grounds, as a hygienic rule, women should not be 
admitted to hospital training before twenty-one or 
twenty-two years of age at the least. Below this, 
the danger to health increases in a ratio directly 
proportioned to the greater youthfulness. [This is a 
point that might well be noted by American law- 
makers, who almost invariably dislike the age limit 
set for state examination and have in many instances 
reduced it by from one to three years from that orig- 
inally set by nurses.] (2) Unhygienic conditions of 
living. (3) Stooped or cramped attitude and un- 
hygienic dress. (4) Overwork and exhaustion. 
But, if German-speaking nurses, or the Sisters them- 
selves, were to arrange these four points, they might 
properly alter their order and place overwork at the 
head of the list. 

Von Lindheim's statistics have been followed by 
those begun under the auspices of the German Nurses* 
Association, which are the only recent ones extant. 
In the imperial insurance of Germany, nurses, as a 
whole, are not among those workers for whom it is 
compulsory. If they were, full statistics of morbid- 
ity and mortality would be kept by the state, but 
they are in the voluntary classes — those who may 
insure if they wish. (As a detail, most of the members 
of the German Nurses' Association do enter the state 
insurance.) 

From the first, one of Sister Agnes's strongest 
wishes was to compile a census of health conditions 
among the nurses. This she finally accomplished 
after strenuous exertions. From her reports, which 
we cannot give in full, the following significant ex« 
tracts are taken: 



The German Free Sisters 39 

Those who, for a decade or more, have lived the life 
of the German trained nurse, and have worked with and 
for nurses, need no figures to tell them how it stands with 
the health of these women. The tragedies met in the 
day's experience, the letters received with their heart- 
rending stories, speak a language that moves and con- 
vinces, but that is spoken to us alone and is not meant 
for the public. In order to prove what we have often 
enough declared, and to bring about, for the reforms 
that we need, measures far more energetic than any we 
have had hitherto, statistical evidence is essential, and 
this has long been lacking. 

Soon after our foundation, we began noting in the 
annual reports the state of health as well as the working 
efficiency of our members. It was a difficult task, as we 
early encountered the obstacle common to all statistical 
inquiry, namely, that many blanks remained unfilled. 
This has now been rectified in great measure by our by- 
law making failure to answer our questionnaires a reason 
for loss of membership in the association, and by the 
exercise of endless patience and manifold warnings. But 
these annual reports gave only a picture of the serious 
illnesses at the time being, not a general survey of the 
complete status of the Sisters' health. To show the 
latter in a really valuable form a longer period of time 
was needed, in order that greater numbers might be at 
our disposal. With the rapid growth of our membership, 
this has with corresponding rapidity become possible. 

In January, 1909, we began an inquiry, and by the 
end of the year 2500 replies were in our hands, so that our 
statistical analysis could be begun. On account of the 
great mass of questionnaires to be worked over, we could 
not attempt sending back those that were incompletely 
filled out. For the future they shall be filled out by 
every new member upon admission, and so any gaps in 
answers be avoided. But will even such records give 



40 A History of Nursing 

the whole truth? There lies a second serious obstacle 
to the statistical demonstration of this, the weightiest 
problem of our professional life. The Sisters will fear 
imperiling their acceptance into the association and their 
appointment to positions, and try to protect themselves 
by their answers. Nor can one always say with confidence 
how much of inaccuracy in reply is intentional. One 
must have lived with nurses for some time before realis- 
ing that, while there are always those who complain 
readily of every little ailment, there are far more who will 
not yield even to serious illness until the last endurance of 
the will has been exhausted — who never think of their 
own health until it is too late, and who ignore or overlook 
in themselves symptoms whose seriousness they would 
instantly recognise in their patients. 

There may be those who, after reading the following 
statistics, may assume that only in our association are 
things so bad, and who may accuse us of not caring prop- 
erly for our members, in not providing work for them. 
However, as our association is only eight years old, and 
as its aim has been to gather together the self-dependent 
women in the nursing profession, rather than to bring 
new elements into it, it has been a nucleus for the union 
of all those women who, entering the work of nursing 
from the most different directions, have found themselves 
compelled sooner or later to stand upon their own feet. 
A number of the 2500 members, whose classified health 
records follow, had indeed been attached to several other 
institutions, as many of them had been in the profession 
for some years before joining us: 1535 have belonged to 
one other institution; 761 to two, and 204 to several 
others before entering our organisation. To specify 
more closely: 383 had been in deaconess houses, 653 
under the Red Cross, 207 in the Diakonie Verein, 200 in 
the Victoria House, 706 in city hospitals, 142 in the 
Hamburg-Eppendorf Hospital, 748 in other institutions 



The German Free Sisters 41 

and associations, 122 in university hospitals, and 543 
in nursing homes [for private duty]. (Many of our 
members still belong to one or another of these institu- 
tions, as a professional organisation is simply supple- 
mentary to them all.) 

The conditions of health of the 2500 Sisters, then, 
with their different ages and varying length of time in 
the service, may be accepted as a fairly typical picture 
of the health conditions of all German nurses, here bet- 
ter, there worse, according to local conditions and the 
degree of care taken of them, the greater or less shortage 
of Sisters, and the sufficient or insufficient numbers of the 
working staffs. 

When our organisation was founded it was well and 
clearly known to those who had been some years at 
work, that the health of German nurses was such as to 
give extraordinary cause for concern. For this reason 
our membership requirements have only called for " abil- 
ity to work" instead of the "perfect health" that is 
always rightly required of probationers. It is greatly to 
be desired that, while the practice of nursing continues 
to be as dangerous to health as it now is, this require- 
ment for probation should be more firmly enforced and 
maintained than is actually the case. Our first dealings 
were with those already in the work, and even though, 
since our foundation, we have directed an increasing 
number of applicants to various hospitals for training, 
nevertheless the responsibility of deciding the physical 
fitness of candidates rests not with us, but with the 
hospitals. The following report, in many places, calls 
for special attention to this point. Certainly the results 
it shows in this connection are astonishing. 

Of the 2500 Sisters, 2423 state that at the time of 
their entrance into the nursing profession they were 
in the enjoyment of health and working energy to 
the full; 32 did not answer; 20 described their con- 



42 A History of Nursing 

dition as "pretty good"; 4 had pulmonary weakness, 
12 had weak hearts, 3 were neurotic, 6 had various 
serious ailments. Thus, among 2500 Sisters there 
were only 20 whose health was not quite perfect, 
and only 25 who were positively unhealthy, when 
they took up the calling. These, then, should have 
been withheld from entering it. It is possible that 
among the 32 who gave no answer some may have 
feared injuring their prospects by answering this ques- 
tion, and their number would increase the figures given. 
But it is by no means in accordance with facts that, 
among 2500 nurses, only 45 should have been unable to 
claim perfect health upon their entrance to nursing. 
The number of women of extremely defective health who, 
in spite of medical examination, are admitted to the 
profession is very much greater than this. Between the 
time of entrance into hospital and that of joining a 
professional association this number diminishes, so that 
the census of our members would give too favourable a 
picture of conditions, if the original conditions were not 
also considered in forming judgment. A considerable 
number of the least strong and well would naturally be 
dropped out during probation, but far too many would be 
retained because of the hospital's need of numbers, and 
would be taken along from year to year until they were 
entirely worn out. We had supposed heretofore that the 
share of this element, which had been unpromising from 
the outset, had been a larger one in weighting our burden. 
The figures that follow thus take on an added significance. 
Hereditary tendency to disease is another point of 
much gravity. We inquired only as to tuberculosis 
and nervous disorders: 254 admitted the former, 
and 76 the latter, in their family history. However, 
among these only 46 cases of tuberculosis and 8 of ner- 
vous trouble have developed. 859 of our Sisters had had 
another occupation previous to nursing. To specify 



The German Free Sisters 43 

more closely, 62 had been married, while 627 had worked 
at one, and 116 at two other occupations. As, however, 
none of their other pursuits could be regarded as inimical 
to health, it seems unnecessary to consider them in 
further detail. The clearest light upon conditions of 
health is given by the table of the age of entrance into 
nursing. The admission of eighteen-year-old girls is 
not unusual, even though twenty is supposed to be the 
usual age. In our inquiry we found 3 who were ad- 
mitted at 15 years; 13 at 16; 49 at 17; 563 between 18 
and 20; and 940 between 21 and 25 years. 

The age of 25 has been pronounced the most desirable 
by various authorities. In foreign countries, where good 
conditions are found, 22 and 23 are usual for admission. 
Therefore, when 1568 of 2500 Sisters began nursing 
before the 25th year, what follows need not surprise us. 
The query as to working efficiency is, to our regret, left 
unanswered by 125 Sisters. Of the remaining 2375, 
1944, or 77.8 per cent., state that their working efficiency 
is unimpaired; 290, or 11.6 per cent., that it is impaired. 
Unfit to work are 141, or 5.6 per cent.; of these, 47 are 
absolutely unable to work, and in the case of 25 of them 
this will be a permanent condition; 94 are unable to 
work at times, and 3 have died since the questions were 
answered. Our table, x showing the age and the number 



1 How long 
nursing 


No. of 
Sisters 


Working 

efficiency 

unimpaired 


Impaired 


Fully 

incapable 

of work 


Can work 
at times 


1-5 yrs. 


875 


798 


50 


13 


14 


6-10 


743 


608 


91 


12 


32 


n-15 


462 


347 


81 


II 


23 


16-20 


191 


124 


43 


s 


19 


21-25 


73 


48 


17 


4 


4 


26-30 


21 


14 


5 


X 


I 


31-35 


8 


4 


3 




X 


36-40 












41-45 


2 


1 




I 





(125 made no answer to this question.) 



44 A History of Nursing 

of years at work, with the present degree of working 
efficiency, sets forth the condition of things most clearly. 

From the statistical tables, which space does not 
permit giving in full, we find that overstrain has a 
bad pre-eminence — 1050 nurses answered the ques- 
tion as to the exact time of its appearance. Among 
them, 277 were overstrained after one year; 180, after 
two years; 163, after three; 106, after four; 88, after 
five; 64, after six; 29, after seven; 30, after eight; 18, 
after nine; and 31, after ten. Then followed tables 
showing the relation of age to impaired efficiency, 
and the proportion of those fully unable to work, 
and those able to work at times. 

So by the end of ten years' nursing 986 Sisters out of 
1050 were overstrained, and upon reaching the age of 
thirty years 739 out of 1050 were overstrained. Rarely 
was the first overstrain repaired. Only too often did it 
constitute the starting-point of manifold ailments which 
were frequently scarcely noticed until they suddenly 
declared themselves in their full, perhaps fatal, might. 
Or, again, the constant effort to pull one's self together 
under chronic breakdowns means chains of painful 
suffering usually borne heroically in silence — for who 
wants a nurse who is not so strong that she may be 
leaned on wholly without thought? And yet nurses 
must not only support themselves, but even assist in, or 
assume outright, the support of relatives. The whole 
gamut of women's heroism is sounded in this, the noblest 
and most inspiring, but — in Germany — most cruel 
calling. 

The Sisters describe their present state of health as: 
good, 1891; satisfactory, 161; poor, 149; variable, 20; 
not satisfactory, 43; bad, 16. 

Others describe themselves as follows: 



The German Free Sisters 45 

Worked-out and fatigued, 42; overstrained, 14; need 
vacation, 16; nervous, 28; ill, 27. From 93 no answer 
has come to this question. 

That the Sisters do not estimate their health quite 
according to their working efficiency is evident from the 
fact that 1944 reported themselves fully equal to the 
performance of work, while only 1891 called their health 
good. 

We attached special importance to the statement as to 
physical condition during the first year of work. This 
was unanswered by 141, or 6 per cent.; of the others, 
1544, or 61.6 per cent., answered that they retained full 
working efficiency during the first year; 504, or 20 per 
cent, were temporarily overstrained; and 311, or 12.4 
per cent., had illnesses. We inquired into attacks of 
illness with the following result: 959, or 38.4 per cent., 
had always been well; 741, or 29.6 per cent., had been 
ill once; 800, or 32 per cent., had been ill frequently. 

After reading the foregoing one cannot be surprised 
that 280 of the Sisters admit having been refused by the 
private life-insurance companies. This number would 
be even greater, were it not that many have not applied, 
because of straitened circumstances or the high premi- 
ums required in late entrance. The number of accidents 
is surprisingly small and it is probable that only the 
serious ones were reported. It is also evident to those 
having intimate knowledge that mild forms of many 
other troubles have not been mentioned — as, for instance, 
slight cardiac neuroses, for otherwise our figure "80" for 
cardiac defects would not be nearly right. Cardiac 
disturbance is the rule among the elder Sisters. 

While 161 8 have not exceeded the tenth year of nursing 
service, there are 755 who have worked longer than that, 
some even up to the thirty-fifth year, and two have nursed 
for forty, though one of these two is now wholly incap- 
able of work. The other still claims working efficiency, 



46 A History of Nursing 

though no one else would agree with her. We were 
especially struck by the prevalent optimism, as we col- 
lected the reports of the physical condition of those who 
had entered hospitals before eighteen. Only ten of the 
sixty-five admitted unsatisfactory health. The others 
designated their health as "good, " although we happened 
to know personally in the case of seven that they had 
serious troubles which threatened them menacingly. . . . 

The very saddest chapter of our theme is our death- 
roll. ... In all, thirty-five of our members have died, 
ten between the ages of twenty and thirty, after from 
one to five years of service ; nine between thirty and forty, 
after from six to ten years; and eleven between forty 
and fifty, after from eleven to fifteen years of nursing. 
Among the causes of death were nine suicides. . . . 

Of the mournfully high total of suicides it must be 
especially emphasised, that in no single instance did any 
love affair or recklessness enter as a complication, and in 
only one instance were there any domestic troubles other 
than illness. In some cases the cause was unmistakably 
acute insanity; in others, physical wreckage of one or 
another form, sometimes traceable to heredity, some- 
times to physical exhaustion or illness. That we should 
continually find cases of alcoholism and morphinism 
among Sisters is not surprising. Those who, exhausted, 
must still keep on working, grasp at every straw of 
support, and pain, sleeplessness, or mental depression 
accounts often enough for the first step toward 
habit. 

In regard to the considerable list of tuberculosis cases, 
it must be plainly stated that, taking into consideration 
the fact that nurses are so frequently undernourished 
and overworked, there is by no means enough care given 
to seeing that nurses placed in tuberculosis wards are 
not predisposed to this infection. An insufficient number 
of nurses is usually the cause of this criminal neglect. 



The German Free Sisters 47 

How many of our 160 tuberculous Sisters must yet 
expiate it with their lives? 

Remembering that an old medical chief in a Mother- 
house who, for thirty years, had held a leading position 
once declared that fully one-third of the Sisters had car- 
diac disorders as the result of over-exertion, but that 
he was helpless to prevent : t under the circumstances, 
we need not wonder at our six cases of heart disease. 

Our association originally expected to reach not so 
much the younger generation as those of longer activity, to 
whom such an association would mean much as a support 
in the struggle for existence. But, although individual 
instances of prolonged nursing service occur, the number 
of those who remain long in the profession is so dispro- 
portionately low that the average working period for the 
2500 Sisters is only eight years and six-tenths! 

In our few years of existence we have gathered small 
sums for assistance in sickness and convalescence, but 
we need hundreds of thousands, yes, millions, in order to 
relieve adequately the distress hidden behind these 
figures. May the Sisters learn from what we have here 
set down; may the eyes of the public, the directors, the 
physicians be opened, that all of us together may help to 
make things right, but, above all, for the future, to 

PREVENT. 1 

Besides the burden of invalidism, German nurses 
are exposed to the menace of poverty, more, perhaps, 
than any other class of workers in the empire, because, 
so far, they have been left out of the elaborate social 
legislation which Germany has enacted to protect her 
people from want. This neglect is readily explained 
by the swiftness of the change in the nurse's position 
from a supported member of the Motherhouse family 

5 Unterm Lazaruskreuz, May 15, 1910, gives the full report. 



48 A History of Nursing 

to a solitary worker. Its sharp lines and contrast 
to the state care expended for other workers, though 
keenly realised by nursing leaders, were only recently 
brought home squarely to the public by a very im- 
portant contribution to social literature, a book 1 
setting forth the whole present relation of German 
laws of all kinds — laws of contract, of hours of work, 
of insurance, of misdemeanours, etc. — to the nurse 
as a citizen, woman, and worker, and showing that 
she is now tied in a sort of legislative patchwork not 
framed with reference to her, and in which she has 
been caught, as it were, unintentionally. 

The story of this book's writing is especially in- 
teresting. Fraulein Reichel, while taking the course 
in a Handels-Hochschule, was required to prepare a 
thesis on "The Legal Status of the Nurse." She 
knew nothing whatever about it, but began visiting 
hospitals and nursing institutions to inform herself. 
However, she found an immediate obstacle in the 
Schweigepflicht rigidly imposed upon nurses in in- 
stitutions, never to speak of any of the details of their 
work or training. This reticence, indeed, was so 
thoroughly impressed upon them that many suffered 
actual legal injustice on points as to which no law 
would compel them to silence. As the "free nurses" 
also were generally quite in the dark as to their legal 
status, Fraulein Reichel entered a training school as 
probationer, and worked through several institu- 
tions until she had acquainted herself with every de- 
tail of the information she was seeking. As she did 
not feel nursing to be her career, she did not finally 

1 Der Dienstvertrag der Krankenpflegerinnen, by Charlotte Reichel, 
Jena, 19 10. 



The German Free Sisters 49 

enter the profession, but wrote her thesis in a style 
which makes it most valuable to nurses. "Except 
in the penal code," she says, "nurses have been for- 
gotten by the lawmakers." And Sister Agnes asks: 
"How many of us knew, before this, that we too, as 
well as the midwives, stand, as a famous midwife 
has said, with regard to certain penalties, 'with one 
foot in the grave, and the other in prison'? " 

The absence of systematic provision for chronic 
invalidism is clearly shown. Fraulein Reichel found 
the general belief, that nurses belonging to Mother- 
houses were cared for under all circumstances, to be 
erroneous. At a notable meeting of women in Berlin, 
in February, 191 1, she spoke on the findings of her 
investigations, emphasising the nurses' unprotected 
condition, the urgent need of a minimum standard 
of payment, and the extreme overwork — a fourteen-, 
fifteen-, even seventeen-hour day being frequent. 
Sister Agnes Karll followed with her story of the 
revelations of ill-health among nurses. She urged 
raising the age of admission to twenty-one, a more 
thorough physical examination, good and nutritious 
food in institutions, sufficient time for rest, a well- 
regulated night duty, and timely oversight of nurses 
to avert their physical and mental ills. She also 
pointed out an unanswerable proof of overwork in 
the excessive number of patients given to one nurse 
in hospital duty, usually from ten to twenty, * — rarely 
as low as five. Besides breaking down the nurse, 
such numbers make the best care of patients impos- 
sible. The audience of women listened in deepest 

1 In the best London hospitals the average is one nurse to two or 
three patients. 
VOL. iv. — 4 



50 A History of Nursing 

sympathy. In the discussion, Fraulein Luders 
spoke of nurses as "the pioneers of professional 
women workers," and as thus having special claim 
to aid and encouragement in their reforms. The 
meeting closed by passing a resolution offered by 
Fraulein Lischnewska, calling upon the state and 
federal governments to legislate for the protection 
of nurses according to modern ideas, and upon city 
governments to examine and so regulate the work of 
nurses in institutions as to secure their efficiency, 
their good health being a part of public hygiene. 
As a basis for such regulation, the resolution asked 
for an official investigation into the conditions of 
nursing. ! 

This public meeting made some impression in high 
places, for, soon afterward, there appeared incident- 
ally in a ministerial paper an order from the Regier- 
ungsprasident of Potsdam, von der Schulenburg, to 
the effect that in all hospitals belonging to his dis- 
trict, the work of female nurses shall be regulated so as 
not to exceed ten or ten and a half hours daily. This 
shows that the criticisms reached a mark. However, 
the comment added to this order, namely, "that the 
complaints of overwork uttered by nurses probably 
originate with those who are either physically unfit 
for their work, or who lack the spirit of renunciation," 
shows how little accurate knowledge exists as to the 
real state of affairs. 

Sister Agnes believes that the next ten years will 
see the real development of German nursing. Offi- 
cial figures show a great increase in numbers. In 
1895 the Imperial Register set the number of female 

1 Unterm Lazaruskreuz, March 1, iqii. 



The German Free Sisters 51 

nurses at 43,946; in 1907, at 74,986. As the growth 
of religious orders is not rapid, this signifies an active 
trend toward secular professional nursing. The 
total probably includes the attendants in asylums, 
indicating a high proportion of ill-educated and 
poorly-trained women. About twenty-six thousand 
in this total were Catholic Sisters; about twelve 
thousand were deaconesses; the Red Cross counted 
between three and four thousand; the German 
Nurses' Association three thousand, with numbers 
rising yearly. 

The National Council of Women of Germany, in 
191 1, numbered two hundred thousand, and they 
have set the nursing question on their calendar to 
receive unremitting attention and interest until the 
strengthening and upbuilding of the associations so 
sorely needed by the army of professional nurses 
shall have been completed, and the politico-economic 
emancipation, which they so urgently need and to- 
ward which they are bravely pressing, shall have 
been attained. In 1912 the International Council 
of Nurses' meeting in Cologne gave to view in high 
relief the strong womanhood, earnestness, and noble 
aims of the German Sisters, and here Herr Regierungs 
u. Medizinalrath Dr. H. Hecker, of Strassburg, read 
a paper on Overstrain among Nurses so weighty in 
its conclusions that its influence must prove epoch- 
making for reforms. 



BOSTON UNIVERSITY 

SCHOOL OF NURSING 
LIBRARY 



^ yt 



CHAPTER II 

OUTLINES OF PIONEER WORK IN SWITZERLAND, HOL* 
LAND, AND BELGIUM 

Switzerland. — The first training school on the con- 
tinent founded on "free" principles was that of La 
Source in 1859 at Lausanne, Switzerland. It was 
the creation of Mme. de Gasparin — who bequeathed 
a large sum for its maintenance — and he: husband, 
and by its charter was named "The Normal Evangel- 
ical School for Free Nurses." Though it was not 
strictly secular, springing, as it did, fr m deeply de- 
vout motives, it was intended to offer serious-minded 
women an alternative to the religious orders, with 
which the ardent protestantism of Mme. de Gasparin 
was not in sympathy. Its founders refused to exact 
celibacy from the candidates, to impose a religious 
dress, or to use the title "Sister," while they em- 
phasised their advanced economic views by making 
the nurses individually free as soon as they had 
taken their course, and by insisting on the honourable 
quality of work done for wages, and on the nurse's 
right to enjoy her whole earnings and direct her 
own career. This unusually free and bold attitude 
made this school to the continent of Europe what 
Mrs. Fry's was to England, 1 but it long remained 

1 History of Nursing, Vol. II., p. 73. 

52 



Switzerland 53 

even more elementary on the professional side, as 
for a number of years it had no hospital training, 
but taught its pupils in out-patient work and in 
private duty. In 1891, under the direction of a 
physician, Dr. M. Krafft, some hospital service began 
to develop in a small way, and will doubtless grow. 
Good theoretical instruction is given, but "training" 
as understood in professional schools does not exi t, 
nor are the pupils well prepared for executive posts. 

La Source may justly pride itself on the number of 
women of exceptional distinction of character and 
ability who have come to it, and they, in turn, cherish 
closely the high ethical ideal upon which the school 
was founded, and believe in its free constitution. Its 
pupils are carefully chosen, about two-thirds being 
well educated, whereas in some Swiss training schools 
uneducated women seem to be preferred. A visitor, 
meeting the pupils in training at La Source in 19 10, 
was impressed with the admirable personalities and 
superior types of the women she saw there. If 
the school is meant to live up to the traditions of 
its origin it will develop on the lines of the Bordeaux 
nursing movement; amplify the Matron's position, 
give up undergraduate private duty, and grade the 
practical work. 

There is a training school in Berne, under the Red 
Cross, founded in 1899, an d one in Zurich, managed 
by the Society of Swiss Women, founded in 1901, 
the former giving two years' and the latter three 
years' training. These institutions have formed an 
association of nurses, but it is wholly under medical 
control, and organisation in Switzerland may be said 
to be in a state of rigid formalism, the nurses not yet 



54 A History of Nursing 

showing initiative or leadership among themselves. 
There are also deaconess Motherhouses, whose 
members are found in many hospitals, hardworking 
as always, and doing beautiful work, finished, con- 
scientious, and thorough. 

There is another secular training school attached 
to an institute of many interesting characteristics, 
namely, that of a Catholic order of nuns at Ingen- 
bohl. This order is young, founded about sixty years 
ago, and is presided over at Ingenbohl by a Mother 
Superior of a splendid type, cordial and frank, in- 
tensely alive and keen. Both teaching and nursing 
are well established, the latter in a good hospital of 
eighty beds, and the teaching Sisters all take the 
nurses' course so that they may continue to hold 
the theoretical work in their hands. The nursing 
methods are modern and excellent, and the secular 
pupils are not overworked. Both nuns and nurses 
carry on their studies and prayers as much as possible 
in the beautiful garden of the institute. The Ingen- 
bohl nuns first opened, in Switzerland, the question 
of state registration, as many of their Sisters worked 
in Germany and felt the influence of the German act. 
They are cordial and responsive to the international 
idea, and may be rightly regarded as a centre of 
ardent and zealous progressiveness in nursing 
education. 

Switzerland has many fine hospitals, well managed, 
and, in the main, well nursed, though it is obvious 
that, in some of them, overwork is the rule for the 
nursing staff. 

The example and influence of the German Nurses' 
Association seem likely to guide or colour, uncon- 



Holland 55 

sciously, the future of at least the German-speaking 
Swiss nurses, while on their French and Italian 
borders, too, the tide is rising which will some day- 
reach them, within the high walls of the mountains 
of their country, and bring them into closer relations 
with the world outside. Perhaps already, in their 
deaconess orders, they have felt the influence of that 
country which gave pastor Fliedner his first glimpse 
of women working as in the primitive church, tc 
which we next turn. 

Holland. — About fifty years ago [wrote one of the 
honoured pioneers of the elder and more conservative 
i?roup of educated nurses of Holland, Mej. C. A. La 
Sastide Baarslag], sick nursing in Holland was chiefly the 
task of religious corporations, especially of Roman Catho- 
lic orders. The Brothers of St. Johannes de Deo have 
for more than four centuries devoted themselves to the 
care of their suffering fellow-members, and a great num- 
ber of nursing sisterhoods are also of very ancient date. 
Not until the year 1830, did there arise in Protestant 
hearts the ardent desire to bring aid and comfort to their 
sick fellow-men, and the Protestant deaconesses took up 
this work of charity. In 1843, the first house of deacon- 
esses in Holland, that at Utrecht, was opened, being in 
the course of time followed by many other institutions of 
that kind throughout our whole country. Some of these 
deaconess houses are affiliated with the Kaiserswerth 
Association, such as the Arnhem Home, founded in 1884, 
and at present supervised by our well-known Mother Van 
Ness. In all these institutions patients are nursed, pay- 
ing different fees according to their financial condition. 
Besides the care of such patients, the Sisters devote them- 
selves to district nursing. 

In recent years we have also developed several private 



56 A History of Nursing 

societies for district nursing, free from any religious bias, 
but founded on the broad principle of human solidarity. 
Of these I will mention two, especially : that at Rotterdam 
originally established by the Dutch Protestant Society, 
but at present on a distinct basis ; the Amsterdam Society 
for District Nursing, and that at The Hague, both societies 
sending out visiting nurses . The patients , who are divided 
into different classes according to their social state, pay 
for every visit at a fixed rate. The poor are aided and 
comforted by the Sisters and are free from any expense at 
all. The nurses have a fixed salary. 

A number of institutions send out nurses for private 
duty ; such are the section for nursing of the Association 
of the White Cross, the Haarlem Nursing Association, 
and others. Nurses belonging to these institutions 
receive a fixed salary (the patients' fees going to the 
association), but nurses preferring to work independently 
(the largest number do so) receive their own full fees. 
Nearly every town in our country has its own communal 
hospital, and the care of the sick is becoming an ever 
greater subject of public interest. Besides these city 
hospitals, where the poor are nursed, there are a great 
many private and special hospitals. 

Devotion and love are indispensable qualities in a 
nurse, but they are not all. A really good nurse cannot 
dispense with knowledge; she must be trained in the art 
of nursing the sick. And in this regard we have made 
great progress in Holland during the last twenty-five 
years and more. The standard of nursing has been 
raised, and the nurse of now-a-days is quite another being 
from the one of a quarter of a century ago. The nurse 
of that time — if we may call her such — was a perfect 
specimen of the Sairey Gamp type, so wonderfully im- 
mortalised by Dickens. To Miss Reynvaan, late Matron 
of the Wilhelmina Hospital, and honorary member of the 
Matrons' Council of Great Britain and Ireland, belongs 



Holland 57 

the honour of having first brought about a thorough 
reorganisation in the nursing world. It was she who felt 
the urgent need of efficient nursing by well-bred women, 
and she herself set the example. Belonging to a patrician 
Amsterdam family, she devoted herself to nursing work. 
Her task of matron in the Buiten-Gasthuis (now the 
Wilhelmina), one of the two public hospitals of that city, 
was a difficult one, but she did not despair, and with 
the aid of Dr. Van Deventer, at that time medical 
superintendent, she attained her noble aim. The male 
and female Sairey Gamps were superseded by a more 
competent nursing staff. Inspired by her words and 
deeds a great number of well-bred and intellectually 
developed women took up nursing work and gradually 
there came a blessed change in the condition of things. 
She has been a noble pioneer on the path leading to the 
elevation of nursing. The need of a special training in 
nursing was more and more clearly realised, and also the 
truth, that theoretical knowledge without practical 
experience was not enough. For this reason certain 
hospitals offered the opportunity for a thorough training, 
the passing of an examination, and the attainment of a 
certificate. The first certificate for nursing was given in 
1879 by the Society of the White Cross. Since that time 
the number of hospitals and societies that grant certifi- 
cates has largely increased. 

We urgently want state registration and fervently hope 
that the new century will fulfil this righteous desire in a 
not too far-off future. In the meantime, the Dutch 
Association for Sick-nursing (de Nederlandsche Bond voor 
Ziekenverpleging), founded in 1892, whose rules and by- 
laws have recently been revised, proposes to evolve some 
order out of the present chaos, and to introduce more 
uniformity and co-operation with regard to training and 
examinations. The different hospitals and associations 
for nursing make different demands upon the candidates 



58 A History of Nursing 

who are desirous of passing examination; a three years* 
training in one of our large hospitals is generally required, 
though some of our institutions still think that two years 
are sufficient. The curriculum, though not quite the 
same everywhere, contains generally the following 
branches: Some study of anatomy and physiology; the 
nursing of internal, infectious, and neurological diseases; 
the nursing of surgical cases, including some knowledge 
of the treatment of wounds and of first aid; the care of 
lying-in- women and the new-born ; some study of hygiene, 
ventilation, feeding, disinfection, bathing, sick-room 
comfort, etc. Special certificates are given by certain 
associations for obstetrical nursing and the nursing of the 
insane. The probationers in the hospitals do not pay for 
their training but, as a return for the duties performed by 
them in the wards, they receive a small salary and their 
living expenses. In most hospitals we find, next to the 
medical superintendent, a Matron, who is especially 
charged with the control of the Sisters. [In small hos- 
pitals one person sometimes combines the duties of 
superintendent and matron, as in the United States.] 
The following conclusions were accepted as principles by 
the medical superintendents and Matrons of our principal 
hospitals, as the result of an inquiry made in 1898. " Pa- 
tients should not be left to the care of untrained women 
either by day or night; day duty for the nurses shall not 
exceed twelve hours after deducting the time needed for 
meals ; day nurses should have an undisturbed night's rest 
of at least seven hours; night nurses shall perform no day 
work; every nurse shall have one holiday every fortnight 
and one evening off duty; half an hour should be allowed 
for breakfast and supper, and one hour for dinner ; nurses 
should have at least two weeks' holiday and head nurses 
three weeks' holiday each year; hospitals should pay the 
nurses' insurance fees for sickness and accident." 1 
1 Trans. Int. Cong, of Nurses, Buffalo, 1901. 



Holland 59 

The Bond, whose resolutions are thus set forth, 
has a mixed membership. Only a small number of 
its members are nurses, the large majority being 
physicians, directors of hospitals, and Matrons. It 
has also some membership among laymen, philan- 
thropic societies, etc., and it publishes a journal called 
the Maandblad voor Ziekenverpleging. Excellent as 
are, without doubt, the motives and aims of the 
nurses and Matrons on the Bond, it has not, from the 
point of view of the working nurses, been an actively 
useful body. In 19 10, most of the points covered in 
the resolutions just quoted are still but imperfectly 
attained. Those who know how to read between 
the lines of these resolutions can readily see that they 
pointed to an existing order of things that was full 
of abuses. It is quite clear from them that patients 
were being nursed at night by untrained women: 
that day duty exceeded twelve hours, not including 
meal-times; that many nurses were not having as 
much as seven hours' sleep; that night nurses were 
working by day ; that nurses had practically no time 
off, no half-days, no holidays, nor sufficient time to 
eat their meals. Were these things not so, there 
would have been no reason for the resolutions. But 
even yet many hospitals place six- weeks' probationers 
on night duty; hours are still too long, even though 
some improvements have been made. 

Especially is it to be noted that the Matrons, part 
of whose duty it is to look after the Sisters, do not 
do so. The reason they do not, is because no real 
authority is given them ; such as they have, is merely 
delegated by the directors, subject to immediate 
withdrawal unless they observe a submissive and sub- 



60 A History of Nursing 

ordinate attitude in all things. The mixed member- 
ship of the Bond, though it may have been planned to 
give full play and interplay to the various elements 
there represented, does not in the very least voice 
the needs and aspirations of the nurses, but only 
acts as a buffer against free expression and progress 
on their part. The influence of the hospital authori- 
ties predominates in the association, and even the 
Matrons have only the passive role assigned them 
of seeming to share in discussions and motions which 
are, in reality, settled as the financial or commercial 
or professional aspects of hospital industrialism 
dictate. 

The Bond has so completely dominated the situa- 
tion that, even though there is in Holland an asso- 
ciation of nursing directresses or matrons, this body 
has been singularly uninfluential in nursing matters. 
In this respect it is in striking contrast to the British 
and American societies of heads of training schools, 
which have consistently assumed a foremost place in 
voicing the professional needs of nurses and in up- 
holding their human rights. It may be said that in 
Great Britain and America the organised Matrons 
have always led, followed and trusted by the nurses; 
in Holland the nurses have led, while the Matrons 
have remained in the background, afraid to assert 
themselves against the hospital directors. The Bond 
is really a clearing-house where compromises made 
necessary by the business circumstances of the various 
hospitals and institutions are agreed upon; it is not 
at all a truly educational or professional body, nor is 
it a highly ethical one. It is a characteristic example 
of that form of organisation that is commended and 



Holland 61 

encouraged by employers who are secretly unwilling 
to permit independent self-governing organisation 
to arise among workers, especially when the latter 
are women, The estimate of the Bond held by thought- 
ful and altruistic women in the nursing profession 
of Holland is indicated in the following quotation. 

The Bond was founded with the purpose of elevating 
nursing — it tried to do this by bringing into the hospitals 
young women who wished to have some useful profession, 
and putting them into the places of the former attendants 
who had been of the lowest orders of society. Full of 
ambition, this new element of well-bred young women 
went to work, but for a great many the task soon proved 
too heavy, for the directors of the hospitals, nearly all of 
whom are members of the Bond, did not realise that it was 
impossible to let those nurses perform the same heavy 
manual labour that had formerly been done by the attend- 
ants. Some theoretical lessons were indeed given, for 
it was admitted that nursing meant something more than 
devotion and deftness, but those lessons, given at the 
end of a long, exhausting working day, were of little prac- 
tical use. The directors did not perceive that the nurses 
needed more comfort, a better training, more spare time, 
and less exhausting manual labour. They did not 
understand that their pupils wanted to learn nursing 
in the true sense of the word, that they wanted to have 
time to solace their patients and make them comfortable, 
to give them all those small cares that sick persons ap- 
preciate so much. As matters stood then the best nurse 
was the one who did her manual work best. The direct- 
ors trained good hospital attendants, but not nurses. 

The results were that after some years the numbers of 
desirable young women applying diminished, and such 
women sought other, less exhausting, occupations. They 



62 A History of Nursing 

saw too many nurses being quite broken down after a few 
years of hospital work or private duty. Some recovered 
their health after a long rest; others still surfer from the 
overstrain. There were then some among the nurses, 
women who sincerely loved their profession, who per- 
ceived that this tendency must be checked and the state 
of things altered, if nursing was to be prevented from 
falling back again into the hands of uneducated and 
vulgar women, It was seen that it was high time to 
found an association to combat and reform many existing 
abuses, and it was felt that it must publish its own paper 
in which to discuss ways and means of obtaining those 
desirable and necessary reforms. For, before 1900, the 
editors of the Maandblad were not inclined to allow nurses 
who had an opinion of their own to have their say in that 
paper. Nowadays, through the force of circumstances, 
matters have changed, but being in the minority in the 
meetings of the Bond, nurses have not much influence and 
dare not speak openly there. 

In May, 1900, a first meeting was held by some liberal- 
minded nurses and physicians, when the outlines and 
form of an association were decided upon. This associa- 
tion, now established under the name of Nosokomos, 
takes only nurses (men as well as women) into full 
membership. Only nurses have a right to vote, or sit 
on the governing board. The physicians who at first 
assisted with the work of editing our journal withdrew 
when it was well under way, and it is now edited by 
nurses. 

Nosokomos owes its inception and the marked in- 
fluence it has exerted in the nursing world to the 
splendid woman who was, until 1909, its leader. 
Miss E. J. van Stockum began her nursing career 
in 1893, in the Hospital for Children in Rotterdam: 



Holland 63 

It was during her training that she first realised how in- 
complete was the system of nursing education, how many 
abuses called for reform, what an absolute want of soli- 
darity there was among nurses. She felt that, as much 
in the interests of the patients as in that of the nurses, the 
latter's servile attitude toward the directors of the hospital 
should change, that they should protest openly against 
the long working hours, and excessive rough work, and, 
above all, that they should be protected against the 
unfair competition of those who were badly trained, or 
even in some cases without any training at all. In 1896, 
she married Dr. Aletrino, who, equally with herself, was 
a warm champion of justice and progress. The original 
plan of uniting the nurses together in one association was 
theirs. 

At the first meeting on the 30th of May, 1900, nearly 
thirty responded to the summons of Mrs. Aletrino and 
two of her co-workers, Miss B. van Mems and Mrs. van 
Regteren Altena. It was Mrs. Aletrino's aim to arouse 
in the nurses a feeling of self-reliance and pride, to make 
them see that they themselves, bound closely together, 
had to make a stand for their own interests — that they 
should not leave that to others. She was particularly 
well fitted for the task she set herself. Her fine intellect, 
broad views, warm sympathies, her willingness to help, 
but especially the confidence she inspired, marked her 
out as a born leader and wise counsellor for all who came 
to her for consolation and help in their troubles. Until 
1909, her husband being her ever faithful co-adjutor, 
Mrs. Aletrino devoted all her time and strength to the 
association, which, in June, 19 10, numbered some 700 
members. Together (she first as secretary, afterwards 
as president, and he as editor-in-chief of the Journal) 
they built up a powerful self-governing nurses' organisa- 
tion. Together they conducted the campaign to obtain 
better conditions, so that it may be possible for well- 



64 A History of Nursing 

educated women to choose nursing as a profession, 
without fearing to have their health, if not irreparably 
injured, at least perhaps seriously impaired after a few 
years' service. It is mainly owing to their intelligent 
leadership and immense working power that many 
abuses have now disappeared, and that great questions, 
such as uniform training, preparatory teaching, state 
examination, etc., are being considered, not only in the 
small nursing world, but also in the wider one of the 
general public. 1 

Another woman of unusual gifts of discernment 
and devotion gave herself to the cause of advancing 
the educational and ethical status of nurses, namely, 
Miss J. C. Van Lanschot Hubrecht, for a long time 
the secretary of the association. She had begun her 
nursing career in 1890, in the Hospital for Children in 
Amsterdam. After some three years there, she had 
a serious breakdown, and afterwards was only able to 
do private duty for short periods at a time. Coming 
back to Amsterdam to live, in 1904, she was elected 
a member of the executive board of Nosokomos, and 
became secretary in 1905. She soon formed a warm 
friendship with Mrs. Aletrino and her husband, and 
under their stimulating influence gave herself wholly, 
with deep enthusiasm, to the work of the association, 
seeing in it a part of the great cause of human pro- 
gress through uplift of the workers and especially of 
women. They met the usual obstacles. 

During the existence of Nosokomos [wrote Miss Hub- 
recht], we have had many difficulties and encountered 
much opposition from physicians and hospital directors, 
some of whom have forbidden the nurses on their staffs to 

1 British Journal of Nursing, Oct. 26, 1907, and other sources. 



Holland 65 

become members of the association. They do not allow 
their nurses independent action or the right to take 
care of their own interests. Every improvement must 
be a favour from the director, to be obtained by a very 
humble request. Although improvements in the physical 
conditions of hospitals took place, the deficiencies in 
careful training persisted, and were the more evident as 
medicine by no means stood still, but advanced with a 
rapidity unequalled at any former time of the present 
civilisation. 

Miss Hubrecht points out the strange inconsist- 
ency of hospital directors in the following description : 

The probationer is not considered as a student to be 
taught . . . she only learns how to do the hospital work — 
she is not taught the full extent of her calling : . . . yet 
the diploma certifies her as capable of nursing all cases 
and affirms her competency as a good nurse. But, when 
she seeks a permanent position, she meets a strange and 
unexpected rebuff; the same authorities who graduated 
her may now answer inquiries about her by statements 
quite at variance with the text of her certificate, and she 
may learn that she has not the knowledge necessary for 
the work which she solicits. The explanation of this 
riddle is simple. . . . These diplomas, which should be 
testimonials of capacity, are distributed with incredible 
carelessness. Every hospital may arrogate to itself the 
right to give diplomas and badges. Women, badly 
trained or not at all, take advantage of this confusion. 
. . . Some months ago, the Bond passed a deplorably 
reactionary measure providing that it need no longer be 
necessary to spend three years in a general hospital of 
not less than forty beds, but that a committee appointed 
by the Bond shall be competent to decide whether this 
or that special hospital, or such and such a small one, 



66 A History of Nursing 

may be regarded as a training school, the decision to be 
arrived at by the whole number of days spent by patients 
in the little place, and the variety of diseases admitted. 
Thus at one stroke the whole principle of a general hos- 
pital training is swept away. The reason of this deplor- 
able decision is not far to seek. It is simply that one 
must defer to the managers of the small hospitals, who by 
this arrangement are able to secure the necessary per- 
sonnel most cheaply. . . - 1 

I have spoken of our lack of systematic instruction; 
whose fault is this? Primarily it is that of the Matrons, 
and next that of the nurses themselves, who, too often 
indifferent and apathetic, lacking in social sentiment and 
solidarity, submit to this state of things, . . . Our 
Holland Matrons have an association, but it is not 
active, nor does it take part in the solution of burning 
questions ; its members do not seem to realise that it is 
their part to put themselves at the head of the reform 
movement and by their words and acts point out the 
way to elevate and advance the profession. 

Yet the demands made by Nosokomos were and are 
very reasonable. It wants a better and more thorough 
training ; a more practical distribution of the hours for 
work and study; shorter hours of work; state regulation 
of training schools, with examination. Nosokomos wants 
the nurses to be independent of all philanthropic aid; 
to make it possible for them to take care of themselves 
in illness, accident, and old age; it wants nurses to be 
really fitted for their work by improving their conditions 
of life and by giving them a thorough preparation for it. 

The strife the young association had to carry on from 
trie outset did not harm it. It made it strong and self- 
reliant, so that those progressive physicians who, in the 
beginning, had helped with its affairs have now with- 
drawn. This struggle has also brought to light many 

« Reports, International Conference of Nurses, Paris, 1907. 



Holland 67 

abuses, which have been rectified after being published 
and discussed. Now that it has attained a secure 
position, its aim is to work more faithfully than ever for 
the attainment of our ideals. We wish to make the 
nurse, by her knowledge and experience, her devotion 
and tact, a real help to the physician; one to whom he 
can entrust his patient with the fullest feeling of security. 
We wish to develop in nurses those qualities which will 
make them real nurses — welcome at the bedside not only 
because of their sympathy, but because of the broad and 
thorough training which makes them a real support to 
patient and family. We wish to have special courses for 
superintendents, matrons, district and private nurses, 
to perfect them in the careers they may desire to follow 
after their three years of training. We wish the training 
and examination to be regulated by law, with the view of 
obtaining more uniformity. Now every hospital can 
give its nurses what training it chooses. We wish also 
to have opportunities for experience in all the lines of 
social and preventive work which will soon be as much 
the nurses' sphere as actual nursing is at present. The 
great merit of Nosokomos lies in the influence it has had 
on all matters relative to the education of nurses and the 
conditions under which they work. Through its exer- 
tions, its bold and open discussion of all abuses, and 
pointing to the way of reformation, much improvement 
has come about. 



Nosokomos was indeed a militant publication. 
For years, it fearlessly attacked every stronghold 
of power and privilege as related to the world 
and work of nursing. It stood with the British 
Journal of Nursing and La Garde-Malade Hos- 
pitalise in its self-imposed mission of combat 
against the mercenary and undemocratic order 



68 A History of Nursing 

which retarded the advance of women workers. It 
never allowed an issue to pass ; it never overlooked 
a detail ; week by week local and national issues were 
held up for scrutiny and criticism. It sometimes 
seemed, to foreign observers, as if its pugnacity must 
antagonise those who might otherwise be friends, 
but this surmise was baseless, for no amount of soft 
speaking would have been of use, as Dr. and Mrs. 
Aletrino well knew. 

The steps taken by the Holland association toward 
state registration have been recorded for us in 
chronological order by Miss Hubrecht. 

In September, 1907, the executive committee of 
Nosokomos sent in a petition to the government asking 
for state registration. Our reasons were set forth in full, 
as published in the British Journal of Nursing, March 14 
and 28, 1908. In December, 1907, a second petition was 
sent, this time addressed to the second chamber of the 
House of Parliament, with the view of explaining still 
more fully, and with many illustrations, why state regis- 
tration is urgently needed. The government sent out 
documents to the Central Health Department asking 
for advice. This board resolved to institute an inquiry 
as to the training of nurses in hospitals and asylums. A 
very extensive questionnaire was made up, bearing upon 
preliminary training, the number of probationers and 
certified nurses in every hospital and asylum, the working 
hours, etc. 

Mrs. Aletrino was called upon for information in 
this inquiry, but, up to the end of 1910, the De- 
partment of Health neither published the results of 
its investigation nor gave its opinion upon state 
registration. 




" a 3 




Holland 69 

In February, 1909, Nosokomos published in pamphlet 
form the two addresses which it had made in 1907 to the 
government, and sent a copy to every physician in 
Holland, enclosing a post-card and asking for an expres- 
sion of opinion as to the desirability of state registration 
for nurses. The result was on the whole very gratifying ; 
one-fourth of all the medical men of Holland declared 
themselves in favour of it. Only ninety-one went on 
record as opposed, while the others did not answer at all. 
In April, 1909, the Association of Medical Superintend- 
ents of Hospitals and Asylums sent an address to the 
government protesting against state registration, on 
the plea that it was not necessary, and was not even 
desired. The arguments were the same as everywhere 
else : that nursing is a work of love and devotion for which 
no fixed rules can be made; that character cannot be 
registered ; that the present state of affairs is satisfactory 
and matters constantly improving under private initia- 
tive, etc. This association had, in 1901, declared state 
registration to be urgently needed; but now, for some 
unknown reason, they had changed their minds. In 
September, 1909, three petitions were sent in, all in 
favour of state registration: one by the Roman Cath- 
olic Association for the Promotion of Nursing, one by 
Nosokomos, and one by the League of Male Nurses. 

During this campaign a number of pamphlets 
were written, and Miss Hubrecht published a book 
dealing with the whole subject. 

The outlook at time of writing was not very hope- 
ful. The conservative, calvinistic ministry of 191 1 
was not favourable to state registration. The boards 
of the deaconess associations and other groups of 
religious nursing orders, whose influence with the 
present government is strong,were absolutely opposed 



70 A History of Nursing 

to it. With them the idea prevails that nurses should 
not be economically independent women, controlling 
their own lives, but must live together as one flock 
with a shepherd. Though trained, they receive no 
certificates, being thus kept in more complete 
dependence upon their Motherhouses. 

Another group in opposition has been spoken of, 
namely, the hospital and asylum superintendents. 
They do not relish the idea of state control and state 
intervention in their ways of managing their insti- 
tutions and the training of their nurses. 

Another difficulty in the realisation of our wishes is the 
fact that nursing is, as yet, hardly held to be a profession. 
The individual nurse will, in most cases, meet with con- 
sideration and a courteous demeanour from the physician, 
but as a group of persons, as a class, they are still largely 
regarded and given much the same place as the servant- 
attendants of former times. The doctors see in the 
nurses not their assistants and equals, but their inferiors. 
I am of the opinion that for this reason many physicians 
oppose state registration. We say it will elevate the 
profession; many of them do not wish it to be elevated. 

I am convinced that there is a deep-lying connection 
between the economic dependence of women and the 
lack of consideration that nursing, as a profession, 
receives, — the unsatisfactory conditions under which we, 
as nurses, are living. Our nurses, even more than other 
women, are, by reason of their isolated lives, inclined to 
submissiveness, and to an apathetic acceptance of bad 
conditions. They are not conscious of solidarity; they 
do not understand the meaning of that word. They do 
not realise the great social strength of unity ; they do not 
seek in co-operation the means to alter present conditions. 
They still harbour the mistaken and unwholesome idea 



Holland 71 

that a good nurse should sacrifice her life, as do the nuns 
and deaconesses, forgetting that the nuns and deaconesses 
are taken care of throughout their whole lives, and that 
their doctrine of work done from motives of love only is 
a sham, since they get their payment in the form of 
lodging, clothing, food, and care in sickness and old age : 
— forgetting, too, that the woman whose life is well 
poised, who gives freely of her love and strength to her 
fellow-creatures — to society — but without squandering 
her vigour, is more useful than the woman who exhausts 
her forces in a few years, only to become a burden for the 
rest of her life. ... In conclusion, we want to point 
out that, whereas the nursing profession is not, as the 
medical profession, under state control, many persons, 
especially in the large towns, often use the nurses' uni- 
form for immoral purposes. They are alternately nurse 
and prostitute, hence the terrible risk of infecting their 
patients with their own infectious diseases, to say nothing 
of the damage done to the good name of the profession. 

For the nurses who do not belong to any religious 
association, the working hours are also very long; they 
live out of the world; nothing is done to awaken their 
interest beyond nursing; no provision is made for them 
in time of illness or old age. 

The nurses' question is inherent in the whole woman's 
question, but as long as they hold aloof on the pretence 
that the very character of their work forbids them to act 
as other women and obliges them to sacrifice all rightful 
claims, it will be difficult to obtain any improvements. 
Only political and economic enfranchisement can be the 
lever to arouse them; — to make them realise how much 
broader and nobler their life can be, once out of the 
narrow groove in which it is at present running. x 

At last, in 191 1, the special committee appointed 

1 Letter from Miss Hubrecht to the editor. 



72 A History of Nursing 

by the Board of Health from its members, in response 
to the request of Nosokomos, made its report. Three 
and a half years had gone by, and the nurses suspected 
that the task had been an uncongenial one. The 
report was negative and lukewarm. 

The committee began its work by instituting an 
inquiry as to the conditions in the hospitals and training 
schools in regard to working hours, preliminary teaching, 
training and examinations, sending out a long question- 
naire to . . . all hospitals, asylums, and nursing homes 
in the country. 

In this way much valuable information was gathered. 
In the report the committee first gives its opinion on the 
most important questions pertaining to nursing educa- 
tion, and concludes with expressing some advice as to 
necessary reforms. But this advice is very disappoint- 
ing. It is true that the desirability of some control of 
the examinations is advised, that certain gaps in the 
training are admitted, and that the wish to remedy these 
is expressed, but all is done in such a hesitating way, and 
is interspersed with so much flattery for the Neder- 
landsche Bond voor Ziekenverpleging, that ... it is 
most difficult to know the real opinion of the committee, 
for every time it points out some fault, or proposes some 
improvement, it recedes quickly, as if saying, "tout est 
pour le mieux dans le meilleur des mondes." . . . 

It was a great disappointment to perceive that the 
committee took sides with the medical superintendents 
and Matrons, and considered the matter from the point 
of view of what kind of training is necessary for hospital 
service, instead of taking the broader view. The inquiry 
proved: (i) That a preliminary training is given hardly 
anywhere; (2) that there is no uniformity in the condi- 
tions of admission of probationers to the training schools; 



Holland 73 

(3) that there is no uniformity in training; (4) that there 
is no uniformity in the examinations. 

Of course, all hospitals insist on good health and good 
morals as the first condition for admission to their train- 
ing schools. As to previous education, some hospitals 
desire the certificate of a higher school; most think the 
instruction given at a primary school sufficient, and a 
few do not even ask as much as that. To anyone 
knowing that in Holland children leave the primary 
school in their twelfth year, it is evident that the com- 
mittee has made a great mistake in declaring that the 
primary standard of education is sufficient for a nurse. 
It shows so clearly in what a low estimate nursing is held 
by the authorities — how it is in their eyes no more than 
an industry which any uneducated person can exercise. 

The inquiry brought to light the sad lack of uniformity 
in the practical training; every hospital has its own views 
upon the matter and acts accordingly, no matter whether 
that training is sufficient to fit the nurse for her future 
career or not. 

. . . The committee is of the opinion that the present 
training is sufficient; that there is no need of a state 
certificate to protect the profession ... it thinks that 
the presence of a deputy of the government at examina- 
tions will mend all matters. 

The committee suggests a few improvements in regard 
to nurses' homes, salaries, and long working hours. But, 
in all these matters, the fact that any improvement will 
cost much money is put forward so strongly that we 
shall not be surprised if the Minister receives the impres- 
sion that the matter is too unimportant to spend money 
on. . . . "Shorter working hours" is at this moment a 
burning question in our nursing world. One of our 
university professors made a speech on the subject 
which roused much indignation among the nurses. The 
jgist of it was that hours are not too long. Probationers 



74 A History of Nursing 

must realise that they can only learn their profession 
by working for long hours, which is synonymous with 
long days in which to learn. They can only show their 
love of and devotion to nursing by working long and 
hard. It is true that many of them are overtired and 
look ill; but there the parents who allowed them to 
become probationers are at fault. Is not that excellent 
logic? 

Our Matrons' Council adopted some resolutions at its 
general meeting last spring, where the same things were 
said. 

And then seeing those young women who are the 
victims of such narrow reasoning, one feels sad. All 
nursing work seems so useless when, in nursing patients 
back to health, the nurses become patients in their turn. 
What profit is that to society? 1 

As we write, nursing education in Holland seems 
to be stationary, but the nurses are strengthening 
their organisation. Miss Hubrecht, president of 
Nosokomos for 19 12, has succeeded in bringing the 
society to open headquarters and unite all its work 
under an office secretary, and has further founded 
a large and active Society for State Registration, 
composed of laymen and professionals. Finally, 
the leading nurses are supporting the woman suf- 
frage movement as fundamental to changed condi- 
tions of education or of work for women. 

Belgium. — In 1909, for the first time, a general out- 
line of modern nursing conditions in Belgium was 
heard by nurses from other countries, to whom the 
Belgian nursing field had been, before, almost un- 
known territory. It was read by Miss Cavell, who 

1 British Journal of Nursing, Sept. 2, 191 1, p. 195. 



Belgium 75 

was herself the English Matron she mentions, and 
ran as follows: 



Nursing in Belgium, though still much behind that of 
England, Holland, and other countries, has made some 
progress in the last two or three years. A desire is evi- 
dent in many quarters to supersede the present ignorant 
and blundering methods by enlightened and up-to-date 
work. The first attempt to alter the existing state of 
things was made by Dr. Depolpe, who instituted lectures 
for lay nurses twenty years ago. They were given twice 
a week, and included a few practical demonstrations. 
The pupils were not attached to a hospital, and they had, 
and have, no actual practical work. The school is still 
carried on under the same conditions, directed by Mme. 
Doequia. 

The hospitals in Belgium are staffed by nuns or by lay 
nurses, the greater part of whom are peasants taken 
directly from the fields, without any training or instruc- 
tion. Where the nuns are in charge, much of the rough 
and unpleasant work is done by lay nurses, who are no 
better than low-class servants. An attempt has been 
made at the Hopital St. Jean to form a regular training 
school. At first the few probationers recruited were 
instructed entirely by doctors. After a time the need 
of a trained Matron was felt, and one was placed at the 
head. Unfortunately, the difficulties put in her way 
were many, and I believe the school is at present almost 
non-existent. 

A mental hospital exists near Brussels, at the Fort 
Jaco at Uccle, where about forty pupils, mostly Dutch 
women, are trained under the able direction of Dr. Ley 
and a Dutch Sister. The probationers receive lectures 
in the usual subjects, and also some general instruction 
in other branches bearing on their work. They pass 



76 A History of Nursing 

examinations and receive certificates, including one for 
mental work. All the pupils are resident within the 
school, a condition unfortunately not general in the 
country. 

The only school which exactly answers to the condi- 
tions of training in England is the Ecole Beige d'lnfirm- 
ieres Diplomees, generally known as the School of the 
Rue de la Culture. This school has been open since 
October i, 1907, and has now [1909] thirteen pupils. 
It was founded by a committee of doctors and others 
anxious to improve nursing, to open a new career to 
Belgian girls of good education, and to train new aids 
in the cause of science. An English Matron was engaged 
to open it, and four pupils formed the first recruits. After 
two months' trial, the probationers sign a contract for 
five years. The first year is passed in a clinic attached 
to the school, where medical cases are received and 
lectures given; the second in a surgical clinic, where the 
lectures are continued; in the third we hope to give the 
pupils experience in infectious work or in the nursing of 
children. A great point is made of discipline and 
character, and the pupils have given proof of much 
devotion and loyalty. 

At Antwerp a certain number of pupils are received 
at the hospital under the direction of Dr. Sano. They 
are not obliged to live in the hospital, and they have no 
Matron. Lectures are given each evening, and examina- 
tions are held for the diploma. Liege, Gand, and Ander- 
leche are also anxious to establish training schools, and 
there is one at Mons which at present is not definitely 
organised. 

In 1908, state registration was inaugurated, and a 
certificate is now given to all men and women who pass 
the government examination. This certificate can be 
gained by following certain lectures during one year — 
practical work is not obligatory. An examination is also 



Belgium 77 

held for a diploma in mental nursing. The state cer- 
tificate shows the erroneous ideas of nursing held in our 
country. The conditions for obtaining it will have to be 
much altered as the work advances. r 

The government examination, which, elementary 
as it is, demonstrates the modern tendency in nursing, 
was brought about by royal edict, this, in turn, being 
the result of agitation and resolutions of the medical 
societies. Nurses seem to have had little or no 
share in obtaining their legal status. The standards 
recognised are: (a) a two years' course in public or 
private hospital; (b) one year's theoretical and 
practical work given by physicians on the subjects 
specified for examination, viz. : anatomy and physi- 
ology, asepsis and antisepsis, medical nursing, record 
keeping, and emergencies. Applicants must be eight- 
een years old and of good moral character. The 
examinations are conducted by physicians. Yet, 
elementary though it be, the Belgian state registra- 
tion has already had a salutary effect in stimulating 
training efforts. The religious nursing orders have 
accepted it, and not only that, have criticised its 
inadequacy in not emphasising practical hospital 
drill, while a central school to provide a uniform 
standard of teaching for the Sisters of the religious 
nursing orders was begun very soon after the pro- 
mulgation of the edict, with results that are very 
gratifying to the friends of the movement. 

The training school spoken of by Miss Cavell as 
being undertaken at the Hopital St. Jean struggled 
through its difficulties so far as to have an official 

1 International Congress of Nurses, London, 1909, Reports. 



78 A History of Nursing 

ceremonial of inauguration in 191 1, in the beautiful 
Hotel de Ville. The school is under the control of the 
city administration, and bright hopes for its future 
now seem justified. The Nurses' Home is in the 
Rue Pacheco, and accommodates twenty or more 
pupils, who receive their practical training in the 
historic and picturesque hospital of St. John, or in 
certain of its divisions. 

The school directed by Miss Cavell is well past 
the experimental stage. In 191 2 it had thirty-two 
pupils, who were in training in four different hos- 
pitals, in each one of which the school placed a 
trained Directrice, on the English system, while 
every ward has a trained head nurse. 

Belgium shows a great awakening in nursing in- 
terests, and progress is under way. Many physicians 
hold liberal opinions, even upon that crux of dis- 
cussion, the Matron's position. Antwerp has a 
municipal school, and there is a Belgian Society to 
Develop Training Schools for Nurses. 



CHAPTER III 

MODERN NURSING IN AN ANCIENT SETTING 

Italy. — Nowhere on the continent, except in 
France, are there such old and interesting hos- 
pitals as in Italy. Judged by their architectural 
and artistic charms, and by the atmosphere of 
antiquity and story in which they are enveloped, 
they are fascinating, but in the light of modern ideas 
fall far into the background. In 1903, an American 
nurse, seeing them for the first time, thus described 
her impressions: 

In going through these hospitals one cannot but feel 
everywhere the entire absence of real nursing, no matter 
how charming the picturesque side may be. So long as 
the patients are not seriously ill, it is not so bad, but 
when one sees typhoid, pneumonia, and other acute 
cases then all the inadequacy of the care strikes one. 
From the nursing standpoint, the worst were the great 
General Hospital at Milan and three of the largest in 
Rome. Everything looked ... as if there were moun- 
tains of work piled ahead which would never be caught 
up with. The nuns in these gigantic hospitals are worn 
and haggard, and one cannot doubt that they are all 
overtaxed, even though nothing is properly done. 

79 



80 A History of Nursing 

The system of nursing that had developed during 
the Middle Ages, producing saints and humble, self- 
sacrificing workers whose names and very memories 
are now lost, has come down to the present day un- 
changed in general outline, but altered for the 
worse in certain details, namely, the diminished 
numbers of nuns and the introduction of secular 
untrained attendants under the authority of the civil 
administration. 

In a word, the transition stage that marked the 
last century in French hospitals had been entered 
upon, somewhat later, by those of Italy. Through 
the pressure of economic conditions the numbers 
of oblates, lay Sisters, and other unpaid workers 
were shrinking, and those of self-supporting though 
ever so poorly paid women, increasing. This eco- 
nomic transformation; political changes, bringing 
the civil government more to the front in hospital 
management and displacing the purely clerical con- 
trol; scientific advance, revolutionising the study 
and practice of medicine and profoundly altering the 
relation of the nuns to hospital work, were the three 
deep-lying factors preparing the way for the indi- 
vidual workers whose careers we are about to follow. 
But before beginning with the doings of the new gen- 
eration, we shall quote from an article written by a 
nurse in Italy, which gives an authoritative state- 
ment of the internal conditions of the hospitals, and 
sets the stage, as it were, for our characters. 

The writer, Anna Celli, has been briefly referred 
to in an earlier chapter. l She was of German birth 
and had been trained as a nurse in the large hospital 

1 A History of Nursing, Vol. I., p. 513. 



Italy 8 1 

at Eppendorf. As Sister Anna Fraentzel she was 
well known in Germany. Her marriage to Professor 
Angelo Celli, famous among physicians for his re- 
search work into, and practical experiments with, ma- 
laria, gave a new direction to, but did not abate, her 
professional ardour. Beautiful and accomplished, 
she threw herself with intensity of temperament 
into the problems about her. She and Professor 
Celli are both Socialists, and engrossed in social up- 
lift. As Socialist member of the Italian Parliament, 
Professor Celli helped to bring about the government 
control of quinine, while Signora Celli visited the 
peasants of large regions, making control experiments, 
taking blood specimens, and in every way assisting 
her husband. She opened and was responsible for 
a dispensary for children in one of the poorest parts 
of Rome. She worked there part of every day, and 
maintained cots for children who needed to remain 
for some little time. She made strenuous efforts to 
initiate the training of nurses, and succeeded in de- 
veloping certain lines of teaching, though without 
founding a regular school. Her greatest contribu- 
tion to nursing reform in Italy was, undoubtedly, 
her strong, accurate published presentation of careful, 
thorough investigations into conditions, and her 
bold statement of facts. Her writings are charac- 
terised by high professional ideals and warm human 
sympathies. 

The servant nurses are the only ones who really attend 
to the sick. Few indeed are the hospitals where this is 
done by the Sisters, as, for example, to a certain extent 
in Rome at the San Giovanni, at the Cottolengo 

VOL. IV. — 6 



82 A History of Nursing 

in Turin, the civil hospital at Udine, etc. Still fewer 
are the examples, as at Pavia and in S. Maria Nuova in 
Florence, where semi-religious orders of women who have 
taken no regular vows are in charge of the wards and 
perform all the most delicate and important duties for 
the sick. . . . The discipline of the religious orders is 
certainly vastly superior to that of the lay nurses, and this 
is of the greatest importance for those attending upon 
the sick. But the admirable discipline of the Catholic 
Church has this one defect : instead of first recognising the 
medical, it puts first the religious authority. This is a 
stumbling block. The service of the sick is looked upon 
as a labour rewarded in heaven, and it is not considered 
necessary to teach it as a profession. It is regarded as a 
religious function. It has happened that Sisters have 
declined to carry out medical orders for children, saying 
that "it was better they should become angels. " In one 
instance, a patient having hemorrhage, instead of calling 
the physician the Sister went for the priest. Another 
allowed a patient with pneumonia to get up on a winter 
night to pray on the cold floor, where, half-dying, he 
was found by the doctor. 

This is not said in a critical spirit, for I am the first 
to recognise the great merits of the Sisters. But 
science is to-day too far advanced for this to be de- 
sirable, and to be a competent nurse it is absolutely 
necessary that the nurse be thoroughly taught, and 
not limited to the religious service. She should oc- 
cupy herself solely with the sick and leave all else to 
others. She should be exclusively subordinate to the 
medical officers and follow rigorously all their orders. 
She should be put through a practical and theoretical 
course, and be capable not only of recognising grave 
symptoms, but also, in times of emergency, of applying 
the remedy. And before practising she should be well 
instructed, partly by the physicians and surgeons, and 



Italy 83 

partly by the trained and qualified head of nurses. She 
should not, from reasons of false modesty, leave the most 
important parts of the care of the sick to attendants, but 
it should be her highest duty and honour to have no 
ignorant person touch her patient. She should not wear 
a dark habit and immense headdress which impedes 
work and becomes a vehicle for micro-organisms, but 
choose a light, washable dress. Until such reforms can 
be made the religious Sister can never be a model nurse 
in the modern sense of the word. . . . 

To-day, the care of the sick in Italy is largely in the 
hands of illiterate lay persons, engaged as servants. In 
general they are admitted from the age of eighteen to 
that of forty years, in one hospital at fifteen, * in another 
at sixteen. In another there is no rule. Usually only 
unmarried women are accepted, because the work 
requires that they should live in the hospital. However, 
in a number of institutions this rule is not in force. In 
two the applicant must spend six months in the laundry 
before being engaged as a nurse. In others she is 
engaged without condition. In five she must give some 
unpaid time — in one, two months, in another, three, in 
another, two years, before being definitely accepted. 
In one it is compulsory to attend lectures, in another it is 
voluntary. In some hospitals practical instruction is 
given, in others, both practical and theoretical, with an 
examination at the end. At Pavia a physician gives a 
course of two months' teaching after the nurses demon- 
strate that they can read, write, and do simple arith- 
metic. At Ferrara a similar course lasts four months, 
with one lesson a week, and comprises medical and surgi- 
cal work. At Siena physicians give a theoretical course 
of six months. If the applicants, men or women, cannot 
then pass a satisfactory examination, they are not 

1 In the original article, Signora Celli gives the names of all hospi- 
tals in full. 



84 A History of Nursing 

accepted. In Florence, every year, the physicians and 
surgeons give a practical and theoretical course of six 
months, and this, as at Rome, may be attended by 
applicants. 

These courses appear well on paper (and they do indeed 
represent a step in advance) , but in reality they often do 
more harm than good. Instead of being of practical 
benefit, they only serve to confuse the minds of the pupils. 
The instructor should be able to descend to the level of 
his hearers, so as to explain things in a way they can 
understand. It is most difficult for young persons who 
have hardly gone through the elementary schools to 
understand any part of so complicated an organism as 
the human body. Instead of being made to memorise 
the skeleton and its parts, would it not be better for the 
nurse to understand the daily functions of the body? 
So it happens that, whether the course is taken or not» 
the ignorance of the pupils remains the same. Especially, 
even when the course is taken, they have no idea of 
asepsis and antisepsis, of diet for various maladies, of 
how to apply treatment, and so on. Who ever teaches 
them their duties toward the sick? Who shows them 
how to make a patient comfortable? Who drills them 
in the cleanliness so essential in a ward or sick-room? 
Who teaches many other necessary little points? The 
physician cannot do so ; often he does not know how him- 
self. No one can do this but a woman, and therefore the 
pupils must have head nurses who can teach them. 

After having passed the requirements of the different 
hospitals, they are taken into service under varying 
conditions. . . . Few hospitals make any provision for 
the old age of their employees; in others they are dis- 
missed when no longer capable. As a result of insuf- 
ficient pay the nurses demand fees, and have a marvellous 
art in extracting something, even from the poorest. The 
relatives of the sick ones, hoping to secure better treat- 



Italy 85 

ment for them, often give beyond their means. I do not 
know whether any hospitals forbid taking fees, but there 
are certainly some where the authorities count upon them 
in paying smaller wages. Then, too, this meagre payment 
often drives the nurses into immoral or illicit ways of 
making money. In general, nurses have the daily care 
of from eight to fifteen patients, and twice as many by 
night, but there are hospitals where one nurse may have 
thirty and more to attend to. 

Tuscany is undoubtedly the most advanced part of 
Italy in regard to hospital service. Siena and Florence 
especially have excellent rules. The work of the nurses 
there is well regulated and their future is provided for. 
On the other hand, in such centres as Turin, Milan, Rome, 
Naples, the service leaves much to be desired. Shameful 
conditions are found in one of the Neapolitan hospitals, 
where the patients nurse one another. When will these 
necessary reforms in the service be made? It is a ques- 
tion of the highest importance for the whole people. 
The service in private duty is even worse than in hospi- 
tals and calls insistently for improvement. * 

Signora Celli concluded her paper by presenting a 
table of figures which she had personally obtained, 
showing the hours of work, amount of wages, and 
standards of food and housing of the nurses. For 
reasons of space we omit this table. The data as to 
hours of work have been summarised in an earlier 
volume. 2 It is enough, now, to say that they ranged 
from twelve to forty-eight hours of continuous work. 
The obstacles, then, to a modern system of nursing 
for Italy were weighty. With mediaeval standards of 

1 "La Donna Infermiera," by Anna Celli; Unione Femminile, Nos. 
2 and 3, 4, 7, and 8, Milan, 1901. 

2 A History of Nursing, Vol. I., p. 514. 



86 A History of Nursing 

technique and nursing, hospitals were staffed by 
cheap labour, for even the nuns belonged in this class, 
since they were supported by their orders, which were 
paid most meagrely by the administration for their 
services. The more technical and responsible parts 
of nursing care were performed by medical students 
and young physicians, who, in the hospitals, took 
the places of our senior nurses, and, in private duty, 
were usually called to be on hand in the houses of the 
wealthy while a nun watched the patient. z Religious 
sentiment, administrative conservatism, professional 
caution, social usage, rigid conventions, medical 
jealousy, and economic bondage offered formid- 
able barriers to a modern invasion of the antiquated 
nursing service of Italy. 

Twenty-five years ago no influence from without 
had ruffled the order of the internal management of 
the Italian hospitals. But it was meant to be the 
prerogative of Old England here, as in many other 
countries, to bring a new element into these massive 
buildings. The love of English people for Italy is 
proverbial. The Italian cities have always held colo- 
nies of Britons, and it so happened that in Florence, 
in 189 — , there lived a Scotch-English lady with her 
family. A born altruist is Miss Amy Turton, pos- 
sessing extraordinary optimism and energy, with a 

1 For private duty there were the Daughters of St. Anna, with its 
house in Siena. Each Sister takes the name of Anna. For district 
nursing there were the Sisters of the Sacred Hearts of Jesus and 
Mary, a new order. An English private duty order working in 
Rome was the Little Company of Mary. These Sisters, though 
doing private duty entirely, do not make any charge, but leave it to 
the patients to give what they will. They are very efficient nurses, 
and do not practise fasts or austerities, regarding the difficulties of 
the calling as their equivalent. 




Amy Turton, the Pioneer of Modern Nursing in Italy 



Italy 87 

gift for setting things in motion that has had notable 
results in many directions. No one else could so well 
as she describe her long, plucky, undiscouraged 
quest during the years when, like Columbus, she 
never remitted the determination to reach her goal, 
and so we begin with her story of the first small 
beginnings in Italian hospitals. 

The idea that something practical should be attempted 
to improve the nursing in our hospitals came to me in 
1890 or '91 in Florence. I used often to visit Santa 
Maria Nuova, and we had a little society — composed 
chiefly of rich friends of mine — for taking food and 
garments to the sick, so that each ward was visited at 
least weekly, and fruit, biscuits, eggs, wine, tobacco, 
snuff, books, clothes, and little pious pictures were given 
to the patients. It was not exactly satisfactory — they 
needed so much, and there were so many of them — but 
we redressed a few serious evils, as I remember, one 
Italian friend especially having wide influence and great 
energy. But the feeling grew: they need some one with 
them all the time who is conscientiously good to them 
and an intelligent aid to the doctors — they need nurses, 
not visitors. 

We heard stories of neglect, of extortionate tips, on all 
sides; we heard the staff quarrelling and saw how 
roughly they moved the patients, and wondered what 
they did or did not do when no one was there, as they did 
so badly when we were present. So the belief grew 
steadily that I must either do more, or give up the little 
I was doing. . . I was free — not too young — with 
sufficient influence to get admission; — a stranger, I 
could do what an Italian could not (for an Italian 
lady could not live in hospitals or even work there 
seriously; her family would object), anon-Catholic, I 



88 A History of Nursing 

could try to help the nuns indirectly, as others could 
not do. . . . 

I believed, and I believe now, that some of us atoms 
of humanity are meant to do one or another bit of work, 
and, despite ourselves, we shall do it. The bit of work 
meant for me was that of the thin edge of the wedge in 
our Italian hospitals — to open their closed doors, that 
others more competent should enter and reform the 
nursing. . . . The thought I held with blind faith was 
— the thing should be done; ... no one else seemed able 
to set the example, so I must begin. 

The difficulties were not slight ; at first it was thought 
best to go to England for a brief training, but we found 
that only by offering to learn could I ask to enter an 
Italian hospital. If it was to teach, there were already 
plenty of trained nurses, but Italy would not admit 
them, except as outsiders, in ambulatoria (dispensaries), 
therefore it was clear that I must find a hospital which 
would take me as a pupil. The next difficulty was that 
there were only nuns and servant-nurses in our hospitals 
— I could enter neither group. My friends tried to get 
me admission as a lay boarder with the Suore at Pisa and 
Cremona, but in vain. 

After some six months Prof. G in Lucca accepted 

the idea of teaching me, that I in turn could teach Italian 
pupils. He admired German hospitals, and wished to 
get a better class of nurses for his wards. I tried to 
board in a convent at Lucca, but the hours were not 
possible, not leaving me free to be in hospital ; — then, too, 
there were children in the house being educated, and I 
might bring infection in to them. Finally, through a 
friend's servant, a family was found, ladies of slender 
means who were willing to take me to board, and I 
stayed with them, without causing any gossip, for six 

months, from January to July, 1893. Prof. G and 

Prof. B ■ were kindness personified. I spent days, 



Italy 



89 



and occasionally nights, in their wards, theatre, and 
medication rooms, and got a good insight into things as 
they were. The surgical technique taught was excellent, 
but nursing? Who could teach me that? ... A St. 
Thomas's friend now visited me, ascertained that I was 
only learning to be a "surgical or medical assistant," 
and told me I must go to England to see what nursing 
was. She advised my writing to Miss Nightingale, 
simply stating where I was in my scheme. I received 
one of our priestess's inspiring letters, then another, and 
another, the third securing me admittance to the Royal 
Edinburgh Infirmary as paying probationer for at least 
six months, or, if possible, a year. 

The professors were doubtful as to the wisdom of this ; 
they could not understand why a nurse should need long 
training; — an intelligent woman could surely get an 
insight into organisation and technique in a few months. 
"In six months," they said, "you can return and then 
we will begin the school." It was useless to try to 
explain to them; I promised only to return as soon as 
possible, and they were to prepare the way for taking 
pupils. I stayed one year, from October, 1893, to 1894, 
at that delightful and beautiful hospital, the late Miss 
Spencer giving me every possible facility. The Lucca 
professors meantime endeavoured to get the hospital 
administration to vote in favour of admitting a better 
class of lay pupils, but politics as usual intervened — the 
plan was "freemasonic and atheistic." The majority 
voted against it, and the professors' attempts ended in a 
definite defeat. This was a blow, but the way closing on 
one side meant trying another. 

Rome came to me through friends who were determined 
that my small efforts should not be so easily ended. 
Professor Rossoni, temporarily medical clinician whilst 
Baccelli was Minister of Instruction, was a friend of 
friends of mine, and he was induced to admit me to work 



90 A History of Nursing 

in his clinic at Santo Spirito, giving permission for two 
or three Italian girls to come also and begin to train. 
This did not succeed; the right girls were not found; 
and after a few months my friends formed a small com- 
mittee to gain admission to S. Giovanni, the Direttore 
Tosti (who is now Director of the new school in Rome 
and one of its warmest supporters) coming on the com- 
mittee with the surgeon Mazzani. The ladies interviewed 
the Mother Superior, and enlisted her sympathies; she 
promised to instruct the Suore to teach all they could to 
the pupils, who were to be prepared for private duty, and 
it was agreed that after six months I should be admitted 
to give the finishing touches to their education regarding 
the specialties of private nursing. 

At this juncture one of Queen Margherita's ladies-in- 
waiting, the Princess Strongoli, heard from a mutual 
friend of the strange English lady who wished to start a 
training school. Nursing had always been on the 
Princess's list of feminine professions, as proposed for the 
girls' college which she was evolving out of the Suor 
Orsola Benincasa Convent in Naples. I was taken at 
eight one morning to talk to her at the Quirinal, and 
convinced her that nursing could not be taught by 
lectures in a school, but required hospital wards. She 
undertook to gain entrance to a hospital in Naples by 
September (it was then June), and offered me hospitality 
at her girls' school. I went as arranged; negotiations 
were in process, and by November I was working in the 
Gesu e Maria and reflecting upon how matters could be 
carried on when I left, for, as I was due in Rome in 
January, I had only the intervening time to give to 
Naples. A nurse who knew Italian was essential; we 
made one or two unsuccessful attempts to find one 
close at hand; finally I appealed to Miss Grace Baxter, 
then in the United States in charge of a ward in the 
Johns Hopkins Hospital. 






Italy 91 

It was one of the inspirations which have attended 
me at the worst moments. She "burnt her ships behind 
her," considering that "Italy's need was greatest, and 
it was the land of her adoption." In January, 1896, she 
joined me, and, after a brief time together, I returned 
to Rome. I took her place that summer for a month, 
and then left Naples to her; — being truly a missionary 
spirit, she has never reproached me, though from the 
worldly standpoint I was undoubtedly the instrument 
which prevented her making a brilliant professional 
career in the States. 

Before taking up the account of Miss Baxter's 
work, our readers shall have a peep into Miss 
Turton' s diaries covering the period just outlined in 
her story; — these daily memoranda give a faithful 
picture of the slow uphill work carried on so 
patiently. 

November 4, 1894. 
I went to ask Signora X. about pupils; she was 
very amiable. I brought her a letter from Marchesa 
XX., one of the patrons of her big professional school. 
She said she would find me exactly what I wanted; 
only I must be prepared to put aside many of my 
"English ideas " ; I told her I was quite willing to do so — 
in fact, I should not wish to retain any ideas that were 
not non-national or founded on the universally accepted 
ethics of nursing ; also that I had begun my own training 
in an Italian hospital. She then explained that educated 
girls cannot be expected to perform ' ' the menial serv- 
ices" for the sick — there must always be servants for 
that part of the work. I tried without success to con- 
vince her that this was against all rules of nursing. But 
I did not venture to tell her that this was the very reason 
why the girls whom she had had taught in Profes- 



92 A History of Nursing 

sor 's courses were not thought capable nurses by pri- 
vate patients, — "nice girls, intelligent and sympathetic, 
but useless." On one point, however, I found her very 
enlightened: she allowed that in time, and with tact, I 
might get girls to nurse in men's wards; it would not do 
to mention the matter at first, — she had not told her 
girls even of the possibility, but, after a few months, one 
of the most intelligent and enthusiastic pupils had 
volunteered to nurse some particularly serious male 
cases after operation, and since then there had been no 
difficulty in getting them to nurse men as well as women. 

November ioth. 
I went back to Signora X. this afternoon; she has 
found two young women whom she thinks eminently 
suited for nurses. One I saw, a bright, intelligent 
girl, a chemist's daughter. She informed me that she 
was not afraid of illness, and that she liked making up 
prescriptions. ... I went to see the other: "Does the 
Signorina wish me to accompany young ladies to the 
Clinica?" Signora X. had not quite explained, but she 
understood it was about young ladies and the hospital ; — 
perhaps her knowledge of French would be useful if they 
were foreigners. ... I explained that it was pupils I 
was looking for and added a little about the work. 
She replied: "Ah Signorina, is it not a life very hard to 
support? I could never venture, and you, also, look far 
too tender-hearted, but even if I had the courage to assist 
the sick, I am all alone in the world, and so would have 
no one to fetch me in the evenings. You see, therefore, 
it is quite impossible for me." ... I see there will be 
the difficulty of chaperonage; only servants have no 
traditions to prevent their walking the streets alone. 

November 23d. 
I am making inquiries elsewhere for pupils; the 



Italy 



93 



chemist's daughter has accepted another engagement. 
It is natural enough that Signora X. should keep 

the most promising girls for Professor as he is 

beginning a new course of lectures, and admitting a new- 
set of pupils to his clinic to be taught by himself and 
his assistant; there is no directress living with them; 
Signora X. is nominally such, but she is not a nurse, and 
only gives the moral support of her presence at lect- 
ures. . . . 

December 12th. 
A promising probationer, Signorina Bianca, has come ; 
she is quiet and nice-mannered — shy of the patients, of 
course; she has never been in a hospital ward be- 
fore. I tried to make her feel at home — no attempt 
at any nursing. ... As we left at seven, Sis- 
ter M accompanying us through the wards, I felt the 

girl was getting frightened ; we talked to her as she walked 
between us, but unfortunately one of the big doors was 
pushed open just as we came to it and the porters 
entered carrying a coffin. I saw Bianca grow quite 
white but said nothing; I put her in the tram and said, 
"good-bye until to-morrow, " but my landlady is certain 
she will not come again. Poor me . . . 

December 16th. 
Signorina Bianca did not appear. Later on came her 
father with a note — she was too badly frightened — she 
returned the muslin and the aprons; this is the end of 
pupil number one. 

December 19th. 
Signorina Antoinette, a promising probationer, has 
been accepted; she has a good manner with the 
patients, is not afraid of them, and is generally self- 
possessed. . . . 



94 A History of Nursing 

December 21st. 
I had to talk seriously with Signorina Antoinette this 
morning, as I found she was calling the servant for what 
Signora X. termed "the menial services," and on my 
refusing to allow her to do this, she frankly expressed her 
objections to performing these offices. I told her the 
nurse's code was to do everything in connection with the 
patient herself, and nothing was "low" if looked at from 
this standpoint, as the simplest things often ministered 
most to his comfort. Her answer was that the educated 
nurse should supervise, but that servants should do the 
rough and unpleasant work. As this was precisely what 
was taught at Professor 's clinic, I found it diffi- 
cult to convince her that the theory was wrong. In 
fact, I see that it will be all but impossible to prevent 
the servants from doing these things, which, from the 
Sisters never doing them, have earned the reputa- 
tion of being low . . . but which evoke the patient's 
gratitude (and tips). 

December 30th. 
Signorina Antoinette told me to-day that she would 
never dream of nursing, if she were not compelled to seek 
the most paying profession open to her, and she was told 
that it would be far more profitable than mending old 
lace; — this was depressing, but her truthfulness pleased 
me. She is genuinely good, doing whatever she does so 
conscientiously; still, after this wet-blanket on my hopes 
for a disciple, I was quite moved by an English girl 
telling me, coming out of church, that she envied me 
profoundly, as nursing was the one thing she had always 
longed to do. This comradeship in feeling was very 
consoling; no one else, so far, quite understands my 
caring to nurse, and I fear that most people find me very 
tiresome for asking their help in inducing others to share 
the strange privilege of doing so. 



Italy 95 

December 31st. 
Signorina Antoinette took fright this morning at a 
suspicious throat case . . . and came to me after rounds, 
saying she could not conscientiously stay. . . . 

February 17th, 1895. 
Donna M. and I have prepared an article on the nurs- 
ing question for the March number of U Ora Presente; 
we treat of the need of more intelligent nurses, and of 
opening a new profession to educated girls, who, at 
present, clog the teachers' market. 

April 25. 
We had a meeting to discuss rules for the Scuola 
Infermiera. The whole matter is extraordinarily com- 
plicated. I am feeling the keenest sympathy for the 
man in the fable who spent his life in getting on and off 
his donkey, in his attempts to satisfy the moral scruples 
of his friends! 

April 30th. 
One of our committee ladies has been to see Signora 
X., and came back quite depressed over the nursing 
question. The danger of contact with the doctors is 
what troubles them. It seems that in the Bologna 
secularised hospital there have been very unpleasant 
scandals. ... I, of course, listen to these disasters as to 
signals, showing the need of avoidance of any semblance 
of lightness in our pupils . . . and also as proving the ne- 
cessity of the power of dismissal being in our own hands. 
... I always feel that the sense of proportion needful in 
guiding others consists in drawing the line justly between 
the "not leading into temptation," and the "trusting 
men, that they may show themselves true. " 

May 7th. 
Our rules are made out at last. The pupils have still 



96 A History of Nursing 

to be found, but we have had the following notice put in 
the papers: "School for Nurses: A committee has been 

formed of the ladies aided by Senator and 

Professor with the object of founding a school for 

nurses for private cases. With the kind permission of 
the Director-General of the hospitals, the instruction will 
be given in one of the Roman hospitals under the super- 
vision of the sanitary authorities and the Sisters, accord- 
ing to the rules of the institution. The course of 
instruction will be theoretical and practical and will last 
two years" (the usual requirements and regulations 
followed) . As we cannot offer the pupils either board or 
lodging, or salary whilst training, . . . and as we have 
had to settle that the pupils should work only half the 
day so as to leave the other half for home duties or 
whatever way of earning they are accustomed to, we 
consider the two years the lowest possible minimum. 

August 31st. 

I am spending a night in Rome so as to have a visit 

to our rive pupils. ... I went to the hospital at ten . . . 

they seemed happy, and told me they liked nursing, and 

were fond of the nuns and the patients. ... It was 

satisfactory to hear from Professor that all had gone 

well . . . that they were good girls and the nuns found 
them intelligent and willing, while the patients were 
always singing their praises. 

January 21, 1896. 
I shall now keep the pupils with me, teaching them 
how to bathe under blankets, change, move, etc., without 
exposing the patient. At present I am to have a room for 
these demonstrations; later I trust there will be no diffi- 
culty about my showing the pupils in the wards what to 
do and making them responsible for doing it with special 
cases. The wards are huge and often overflowing; the 



Italy 



97 



Suore and servants overworked, so that we can really be 
of use and comfort, if only the oft-prophesied feelings of 
distrust and jealously can be avoided. 

January 26th. 
At 8 a.m. the professor and house doctor went the 
rounds with the Suore and two of our pupils. Sister M. 
Cristina, the head of this ward, is such a sweet woman; 
I am thankful we are to work first in her ward. The pro- 
fessor told her he would like her to put beds in my hands 
for teaching the pupils, and she was quite pleased and 
anxious to give us the worst cases, saying, "then they 
would have more constant attention. " That is the true 
nurse spirit . . . We have two pneumonias, one obscure 
fever case, and one obscure, without fever. The ward is 
very heavy, and one can't help seeing, after English 
wards, that want of system in several respects makes it 
heavier. It is painful, too, that backs are not rubbed or 
hair combed except once a week, and consequently bed- 
sores and lice are more or less taken for granted. What 
is well done here is the administration of medicine. The 
patients do not take it themselves, as in many hospitals, 
but it is kept on a neat little tray and carried around and 
given by a Sister at the proper hours. 

February 10th. 
It is rather serious lecturing to pupils who have no 
sense of humour. In telling them the other day of the 
nurse's need of persuasiveness and tact, I mentioned the 
very disastrous habit of allowing a large number of 
persons to be in the patient's room . . . adding at the 
end of my remarks that, if doctors were in question, the 
nurse could not make any suggestion but could only pray 
they would go away. One of my pupil's notes, handed to 
me for correction, read: "It is very harmful to have too 
many persons in the room, but if they are doctors, the 



98 A History of Nursing 

nurse shall not make any observation to them, but shall 
pray to God that they may leave !" Regarding a matter 
I have most at heart, they all seem to understand: I 
mean the sacredness of what nurses see and hear when 
people are in trouble. . . . 

March 226.. 
We have got leave to wash our patients. ... I spoke 
first to the chief, who was delighted, then to the inspec- 
tor, who was also quite in sympathy, and told Sister M. 
Cecilia to provide basins, rubbers, and soap. This she 
smilingly did, and we began this morning — cautiously, 
lest some be alarmed and object. But no one made 
difficulties, and most were touchingly grateful. One 
poor old man did at first refuse, but when asked for the 
reason he explained that he was ashamed, as he had been 
ill for many months and his feet had never been washed. 
. . . Those who were up helped to change and fetch water, 
and the whole scene was most cheery and friendly. We 
gave only two real "bed-baths, " as there were a hundred 
patients, but we washed the feet of the bed-patients of 
one-quarter of the ward. 

April 25. 
The first year's examination is over . . . the aptitude 
and trustworthiness of our pupils make us quite happy 
and hopeful of their ultimate success. 

The time had now come for Grace Baxter to enter 
upon the scene. The harmony of the sequence of 
events in her career, by which she was unconsciously 
prepared for her life-work at the very moment when 
it was ready and awaiting her, has been reflected in 
the unwavering fidelity and efficiency that she 
brought to it. Miss Baxter was born in Italy, and 
had lived her life there up to the time when she came 



Italy 99 

to America for training; she was, therefore, in one 
sense, an Italian. Her parents were both English, 
scholarly, literary, and idealistic ; x loving Italy as the 
English of their type do, their home was in Florence, 
where Miss Baxter grew up. The writer knew her 
well in the Johns Hopkins Hospital during her train- 
ing : a serious, lofty-minded, most simple and direct 
nature, completely averse to all sham and pretence, 
very quiet as to her opinions, but of great independ- 
ence of mind, holding views on the great funda- 
mental questions of life that were untrammelled in 
their natural strength and freedom. Hers were high 
standards of daily living, based upon truth, justice, 
and a great compassion for humanity. Immediately 
upon her graduation she left the Johns Hopkins and 
sailed for Naples, where her work lay in the large 
public hospital called the Gesu e Maria, a beautiful 
old pink and yellow stucco building, with large 
cloisters and gardens. The wards are old-fashioned 
but pleasant. Her residence was in a little house on 
the domain of the school for girls already referred to, 
which had been established in wonderfully beautiful, 
picturesque old convent property, built upon a 
series of terraces with bewildering gardens, corridors, 
cloisters, and salons that lent themselves perfectly 
to their new uses. 

This girls' school, the most complete and progres- 
sive educational institution in Italy, had been called 
into being by the Princess Adelaide di Strongoli, lady- 
in-waiting to her Majesty Queen Margherita, and 
one of the really great educationalists of her day. A 
fearless woman and untiring, far-sighted worker, her 

1 Miss Baxter's mother wrote under the name " Leader Scott." 



ioo A History of Nursing 

devotion to the cause of practical education led hel 
to become the first patroness of trained nursing in 
Italy, and it is certain that without her firm support 
and steady financial backing the Blue Cross Society 
(the name given to Miss Baxter's nursing school and 
its graduates) could not have existed. In personal 
service, too, the princess has won her laurels, for in 
1884 she received the gold medal for active assist- 
ance in the great cholera epidemic. 

Miss Baxter's entrance into the routine of the 
hospital was effected very quietly. There were local 
reasons why the nuns had given up the management 
of certain divisions, and in these she began the new 
order. Probably no one with a less complete arma- 
ment of weapons in her perfect knowledge of Italian 
characteristics and customs, and her own heredity 
and training, could have maintained this position. 
It was so unusual to see a woman who was not a nun 
in a public hospital, that even some of the medical 
staff mistook her motives, and had to be assured that 
she had come there for work and not for frivolity. 
In the director, however, she had from the outset a 
chivalrous, old-school, fastidiously honourable chief 
and ally, whose support meant everything to her. 

Miss Baxter's letters to America told some of the 
incidents of her hospital work and the often amusing 
obstacles to progress: 

OSPEDALE CLIN1CO, NAPLES, 

January, 190 1. 

Have I told you how I started my school with three 

nurses, one of whom soon left, while the other two were 

so well satisfied with themselves that they sailed through 

their ward work superciliously and listened to my 



a 




■^ 



Grace Baxter 

Superintendent, Blue Cross Nurses in Naples 



Italy 101 

theoretical lessons with a scarcely veiled smile of pity at 
the idea of my taking so seriously what appeared to them 
elementary knowledge? I had not at that time an official 
position, which made my humiliations all the harder 
to bear. The revolution took place during my summer 
holiday ... a new set of doctors were elected, who 
knew me and upheld my authority. I was now officially 
accepted as head nurse of — nobody knew exactly what. 
My position grew of itself, and I have crept up by slow 
degrees, gaining or losing ground according as I have won 
or lost the innumerable little battles which I fight every 
day. . . . My subordinates are the cross of my life, although 
we are excellent friends, because they do not and never 
will understand so much as the elements of discipline. 
When I returned to Naples in September, I found that the 
Princess of Strongoli had been busy all the summer pub- 
lishing articles and getting up new subscriptions: the 
result was that there were fourteen new pupils waiting 
for me besides the three who had begun in June. Of all 
these, ten have just passed their junior examinations. . . . 
Lest I be accused of deliberately departing in my sys- 
tem from the time-honoured methods of alma mater, 
let me protest that to make any way at all I must insert 
the thin edge of the wedge and not the thick one. Any 
other course would most assuredly end in my offending 
irrevocably the customs and prejudices of the country. 
After much discussion among themselves, my suggestions 
being waved aside, the staff made out a programme of 
theoretical work. It was decided that there should be 
an hour's lecture given daily to the nurses by the phy- 
sicians, the first-year subjects being anatomy, physiology, 
hygiene, surgical and medical pathology; the second year 
gynecology and obstetrics, diseases of children, first aid 
to the injured, diseases of the eye and ear, and dietetics. 
On discussing the position of my pupils, the Blue Cross 
Nurses, as their official title runs, I could not obtain the 



102 A History ol Nursing 

dismissal of a single one of the existing "servant- nurses. * 
The result is that my pupils' ward work has never been 
anything but voluntary, for, if they do not perform the 
duties required by the patients, there is someone else 
there to do them. . . . My pupils come on duty at 
eight A.M., coming in from their homes, wherever they are. 
They do ward work and make rounds with the staff until 
eleven, when the lecture is due. When this is over I go 
over the lecture of the day before with them, explaining 
the difficult passages. We then return to the wards, and 
between two and three p.m. the pupils leave the hospital 
and return to their homes. . . 

Perhaps you will realise what is required of me when 
I tell you that no nurse is allowed to remain in the four 
wards unless I am walking the hospital and making 
myself as ubiquitous as possible. If I go upstairs to 
lunch or to rest for more than a few minutes, I must 
collect my flock, no matter what they are doing, and 
take them with me. After the pupils have gone home, 
I spend the afternoon and evening in writing up the 
notes of the lecture for them to copy. Though they are 
fully up to the standard of the average English girl in 
social status and refinement, they are too inexperienced 
to take down correctly the scientific and technical lect- 
ures, and this is better than revising all their written 
notes. At the beginning of the year, I wrote out a 
programme of the subjects I considered indispensable for 
nurses, copied from my hospital notes. The chief, whose 
ideas on nursing matters do not differ greatly from those 
prevalent in English hospitals, agreed with me. The 
lecturers, however, enlarged a good deal on theory and 
technicality. In the course of the year they have 
realised that we need simple facts. 

I put my nurses into uniform in February. The 
material is rough gingham, striped blue and white, with 
turn-down collars, high white aprons, and hemstitched 



Italy 103 

half-sleeves. Caps would have been against the ideas of 
propriety here, and I did not suggest them. 

With regard to ward work : during the first few months, 
not having any graduate nurses to help me, I was obliged 
to leave three out of the four wards to the servants, and 
give my practical lessons in the fourth. After six 
months' training I was able to place the pupils in charge 
of the wards, always of course under my direct surveil- 
lance, and the results have been such that the ward 
physicians are fully persuaded of the value of our school. 
The nurses take temperature, pulse, and respiration, do 
up the bed patients, and wash and comb the others, 
catheterise and give douches, prepare for surgical rounds 
and medical emergencies, assist at operations, distribute 
medicines, and give hypodermics. What they do not do 
I will try to explain. They are not allowed to make 
temperature charts, lest they should presently usurp 
others of the doctors' functions, but I have taught them 
unofficially to keep special charts of interesting cases. 
They may not make beds in the morning except for regu- 
lar bed patients, bed-making time being four p.m., and 
not every day of the week either. In the men's wards 
the servants are forbidden to turn the mattresses except 
on Thursdays and Sundays, though the sheets may be 
changed several times a day. There are two reasons for 
this extraordinary regulation : first, the floors are washed 
daily at five a.m. by the servants and any subsequent 
bed-making would nullify their work, sweeping being also 
prohibited ; second, there is so much phthisis in the ward 
that it is inadvisable to make much dust; for the same 
reason sheets may not be shaken out in the ward. 

Bed baths are permitted in theory, but merely tol- 
erated in practice. For this reason I have to get them 
done in the early morning, before the director and the 
ward doctors appear, lest on some inauspicious day they 
be prohibited altogether, and this in the women's wards. 



104 A History of Nursing 

In the men's wards, although I myself might bathe any 
patient, the permission is not extended to my nurses, 
who may only wash the men's faces and hands. The 
general ablutions are entrusted to the servants, who take 
advantage of the loophole of escape and bathe none. 
Nor can I insist. Diets are entirely out of the province 
of the nurses except in the matter of feeding helpless 
patients, and under no circumstance would they be 
allowed to enter the kitchen. Before the training is 
finished they will go through a course of cooking, but it 
will be outside the hospital. . . . The ward cleaning is 
done by the servants, of whom there are three to each 
ward. Their business is to keep the place dusted, 
washed, and burnished, and I must say for them that, 
with due allowance for circumstances, they do their work 
well. The director does not wish the nurses to interfere 
with this part of the work as a rule, so that they only do 
so in exceptional cases. I feel the less troubled about 
this, as all my nurses are taught at home to do housework. 
The disinfection of utensils, linen, etc., and the sterilisa- 
tion of nozzles, instruments, etc., is entrusted to the 
nurses. 

Medical rounds are carried on in a very delicate man- 
ner when we are present, a feature due to the refining 
influence of the chief. Even in the men's wards there is 
nothing which could shock the most puritanical mind, so 
that the pupils' parents, who at first stipulated that their 
daughters should nurse only women, now prefer these 
wards to the others. The only difference in the system 
of rounds here from that familiar to other nurses is that 
the ward doctor's assistant, instead of the head nurse, 
takes down the orders. T . . . 

To illustrate further the difference in social customs 
in Italy and America, and the influence which they exert 
on hospital life, I will mention that during the year I have 

1 Foreign Department, A. J. N., March-July, 1901. 



Italy 



105 



had to deal with two love-affairs between nurses and 
doctors. Now this may seem of no great importance to 
Americans, but in our case the incidents nearly wrecked 
our fragile bark. It is significant of the opinion in which 
love-affairs are held, when not carried on under the direct 
aegis of the parents, that the director, when he heard of 
them, behaved as though the affairs had brought dis- 
honour on the whole institution. It was with the very 
greatest difficulty that I persuaded him not to discharge 
the entire staff of medical assistants, twelve in number, 
for the offences committed by two only. My pupils 
being very young, I honestly believe them not to have 
been so much in the wrong as the doctors who had dared 
to admire them from afar, but I could only save them by 
keeping them out of the way for days after, and as it is, 
they must take the lowest rank for months to come. You 
will have realised by now that since the feasibility of a 
"lady nurse" remaining unchaperoned in the wards is 
denied to us in the first place, there are greater difficul- 
ties in the way of conducting the work of the hospital 
with trained nurses of the educated class than at first 
appear. I confess that I do not yet see my way through 
it. A few love-affairs of the kind mentioned, though 
innocent enough in Anglo-Saxon countries, would in 
Italy ruin a serious undertaking such as ours, to its very 
foundation. . . . 

Our school is growing slowly but surely, and has come 
to be looked upon as one of the institutions of the city, 
so that only last week we were asked if we could under- 
take the nursing of the big hospital for incurables. Un- 
fortunately our number is too small for such a colossal 
undertaking and we have had to give up the idea for 
the present. . . . Now that our position is assured, we are 
able to choose our nurses from respectable middle-class 
families, but owing to our exclusiveness we cannot for the 
present get as many as we need. ... In the hospital 



106 A History of Nursing 

where we were once despised and ridiculed we are now 
appreciated and sought after. When two new wards 
were opened last month the chief, Professor d'Antona, 
requested me officially to let him have enough nurses to 
run them, and his assistants were even heard to say that 
they could not be opened without us. We have now 
one hundred and ten beds. Another very satisfactory 
incident was the request of Professor Bianchi, one of the 
greatest neurologists of this country, for two nurses to 
take charge of the clinic for nervous diseases just opened 
at S. Andrea della Dame. They were duly installed and 
are working satisfactorily. Seven of our graduate nurses 
are in positions as head nurses in this and other hospitals. 
Many more could be so placed, but the salaries offered 
are ridiculously low. The nurses have more work 
offered them than they can do." 1 

Only a few years later the Blue Cross nurses were 
firmly established. They spent the full day in hospital 
instead of a few hours ; were in charge of seven instead 
of four wards, and in the children's took the entire 
service both day and night; wore uniform and cap 
and were no longer expected to be chaperoned, but in- 
stead held head-nurse posts in a number of hospitals. 
One went to Rome to the new school as head nurse 
of the operating rooms, and for a long time they had 
carried on the work of a small dispensary for anaemic 
and rachitic children in Naples that was supported 
by voluntary contributions. Among those who first 
stood alone must be mentioned Signorina Tonino, 
who pioneered in Rome before the new school was 
opened, helping Miss Turton with her little group 
of pupils in San Giovanni. Her work there was aided 

*A.J. N., June, 1903. 



Italy 107 

and watched over by the Princess Doria, in the very 
wards where an elder princess of that name, several 
generations earlier, had founded the hardworking 
and practical order called the Sisters of Mercy. Nor 
would the sketch of Miss Baxter's surroundings be 
complete without a line for Signora Adelaide Pagli- 
ara, the secretary and registrar of the Blue Cross 
Society, the strong, practical, gifted friend and ally 
of the school and its pupils, whose encouragement 
often revived hope and chased away depression. 

The growing interest in skilled nursing undoubt- 
edly received a great impetus from the meeting of the 
First National Congress of Italian Women which 
took place in Rome, in April, 1908. This was a 
stirring and most important gathering, attended by 
over a thousand women from all classes and parties, 
where every detail of the modern social structure in 
its special relation to women, and every aspect of the 
status of women as related to the progress of the race, 
were discussed with earnestness, brilliancy, and learn- 
ing. The nursing question was taken up at one 
session, but, regrettably enough, the organisers of 
the congress did not secure the presence of nurses 
themselves upon the programme. It is a pity that 
Miss Turton, Miss Baxter, and Signora Celli had not 
been persuaded to report upon the work of nursing 
in Italy. 

Nevertheless the papers read were of great in- 
terest and value. Signora Sciamanna, of Rome, 
an enthusiastic amateur who had worked in the 
Roman hospitals as a volunteer, read the leading 
paper stating the nursing case for Italy ; she described 
the low plane of the injermiere and their defective 



108 A History of Nursing 

education, long hours, low wages, immoral ten- 
dencies, and absence of discipline. She described from 
life an incident she had seen, where the nurse, sup- 
posedly remaining beside a dying patient to adminis- 
ter oxygen, was in reality so absorbed in a trashy 
novel that she did not notice when the patient ceased 
to breathe. She advocated schools for refined women 
to be annexed to hospitals, but showed her limitation 
of ideas of a future for nursing, by contending that 
nurses should be prohibited from joining leagues or 
federations controlled by themselves. She had ar- 
rived at this opinion by the fact that the oppressed 
attendants had formed unions and resorted to strikes 
in order to better their wretched economic con- 
ditions. z 

Professor Mengarini, a woman, spoke also on the 
nursing question; she had little direct knowledge, 
but took a larger view of human liberty and pro- 
tested against its curtailment by the prevention of 
self-governing associations. 

A resolution presented by Signora Dacher closed 
the discussion. It ran, in effect, as follows: 

The Woman's Congress asks that there may be one 
educational programme for all Italian nurses, to be ap- 
proved by competent authorities, and that no one be 
allowed to exercise the profession who does not possess 
the diploma. The admission of candidates should be 

x The infermiere, long unorganised and defenceless, had finally 
formed leagues for mutual support in the different Italian cities, and 
by 1903 there were 29 such leagues united in an Italian federation, 
having a journal called V Infermiere. In 1904 this body was strong 
enough to hold a national congress in Rome. Through its efforts and 
influence many improvements in the economic status of the attend- 
ants had been brought about. 



Italy 



109 



regulated by the same formalities as are in use in other 
professional schools. The principle of equal pay for 
men and women should be recognised. 

We shall now continue Miss Turton's narrative, 
which traces the steps finally leading up to the open- 
ing of a model training school in connection with the 
Polyclinic Hospital in Rome. 

The following years held attempts in Rome and in 
Florence which bore fruit very incommensurate with the 
efforts made by friends and patrons, but which brought 
Princess Doria always more and more with heart and 
soul into the crusade. Few girls were found to risk the 
chances of success, when we had no home and no pay and 
only insufficient training to offer them. But enough did 
come forward to prove their aptitude and keep the ball 
rolling, and the Casadi Cura 1 episode in Florence, where 
six or seven Italian nurses cared for private patients with 
some help from English nurses and from the Blue Nuns 
(the most sought-after private nursing order), leaves 
memories of many happy hours. But the hospital reform 
was still in abeyance and time was going. A friend offered 
money to start a training school in some hospital, and 
Bologna nearly accepted, but a tragedy in the Pro- 
fessor's family closed that door. A scheme to run a 

1 The Casa di Cura, a private nursing home, was one of the 
creations of Miss Turton's executive energy, and a notable success. 
In the midst of her other undertakings, she also found time to pro- 
ject, plan, and build a sanatorium for incipient tuberculosis cases, 
the first in Italy. It is near Florence and accommodates eight girls 
or women. She began raising money for it in 1902 and it was opened, 
with a nurse in charge, in 1904, turned over later to a society founded 
to aid incipient cases, and is now nursed by nuns. It was described 
for the International Tuberculosis Congress in Washington in 1908. 
See Transactions; also American Journal of Nursing, November, 
1908, p. 124. 



no A History of Nursing 

private hospital in Rome was next brought forward, and 
a shareholding company formed, but the speculative 
spirit swamped the original plan of balancing paying and 
free patients, a school being impossible with only the 
former. It was fated that this door also be closed, and 
the building was sold before completion. 

New elements had now come into the campaign. 
Signora Maraini Guerriere Gonzaga, wife of a member 
of Parliament, absorbed the fundamental principles of 
pioneer reform, and became the Voice which we had all 
along needed. Italian, she knew the standpoint of her 
compatriots ; in sympathy with the Princess Doria, Miss 
Baxter, and myself, she gradually became the handle of 
the wedge, inserting it with such enlightened intelligence 
that the Polyclinic doors were finally opened to a real 
training school. But this did not come about directly . 
There was first an attempt, after the Women's Congress 
and Signora Sciamanna's speech on nursing, to start a 
school in connection with the Cliniques, the Matron and 
pupils living in a house near-by. The project was neve? 
a satisfactory one, as the Matron would not have had the 
nursing organisation nor oversight of the wards entrusted 
to her, but only the teaching of the pupils within the 
school. 

[In the medical Clinique Signora Celli is head and 
in the surgical there was, before her remarriage, 
Signora Sciamanna, each having her own paid staff 
of nurses.] 

Pupils living outside with a third Matron would 
thus have been too literally outsiders, with insufficient 
responsibility. Difficulties closed this doorway also, 
then a sudden inspiration seized Princess Doria and Mme. 
Maraini: "Let us make a desperate effort to get a real 
hospital block to nurse, — Professor Bastianelli's, — and 



Italy in 

get a nurses' home somehow in the Polyclinic. " It was 
only one year ago that this plan came into being. Talked 
of in March, when the earthquake excitement had sub- 
sided a little, pushed, guided, lifted, dragged, — it was 
finally accepted by Queen, Government, and hospital 
authorities, the ground chosen, the plans drawn, and work 
begun by the end of June. During the summer the little 
Home was hurried forward, and on the 28th of February 
Miss Dorothy Snell, Miss Reece, and I entered it. Per- 
haps the most remarkable feat accomplished by our 
committee was in securing the acceptance of a foreign 
staff as teacher nurses. As soon as Italians can be 
trained to replace the English contingent they shall 
assume the posts. The staff, however, does include one 
Italian, Signorina Sciarrino, who was trained in Buffalo, 
New York State, and took post-graduate work in Bor- 
deaux with Dr. Hamilton. The nuns remain in charge 
of household administration. 

The English Matron, Miss Dorothy Snell, has been 
described as "a woman of great power, intuition, 
and intelligence; very spirituelle and diaphanous in 
appearance, but with an iron will — a born leader." 
She and her assistants made a success of their work 
from the first. Miss Turton lives in the school as 
one of the faculty — a sort of fairy godmother whose 
wand will ward off harm. In a letter to England, 
she described the auspicious opening of the new 
regime. 

Roma, April 17, 19 10. 

Fourteen days ago the little band of pioneer nurses, 

with their first ten Italian probationers, took over the 

nursing of the first surgical pavilion here — a small 

beginning, seemingly, but one which we believe will have 



ii2 A History of Nursing 

wide-spreading results, and is consequently worth what- 
ever it may cost in effort. The fourteen days and nights 
have been strenuous, physically and mentally. Five to 
eight operations on alternate days, dressings of the ma- 
jority of the seventy-five patients and " specialing" opera- 
tions and hopeless cases have proved the need of an 
ampler staff, and Miss Conway has come on from Bor- 
dighera (kindly spared by Miss Bryant), 1 and Miss Beau- 
foy is starting from London, to aid with hands, minds, and 
tongues (they speak Italian) in the "great endeavour." 

It is difficult to give details of the work — of what is 
being reformed, for we are, in a way, guests in a foreign 
land. We want to help, not to criticise. Years ago 
Miss Nightingale wrote me, when I returned to Italy 
after my year at the Royal Infirmary, Edinburgh: 
"Patience and prudence, as, e.g., not extolling English 
things to Italians, or saying, 'I do so and so in Great 
Britain.'" Theoretically speaking, this standard is the 
only one compatible with courtesy; but reformers cannot 
always wear velvet gloves. Much must be wrestled 
with, much uprooted, only we should always aim at 
doing silently. And consequently it is not an easy 
matter to write anything that is really true all round. 
Another saying of Miss Nightingale's often comes back 
to me. A year later, when I was going to Naples, leaving 
our first Roman pupils to the nuns at S. Giovanni, she 
wrote to me: "I am sure you will remember it is only 
personal work that can do things. Stand your ground 
and kiss your enemy's nose is one of the secrets of life. 
... A large Tom cat of mine came into the room and 
ran at my two little kittens. The larger and handsomer 
kitten ran away. The smaller stood her ground till the 

1 Miss Bryant, a young English woman, had been trained in 
Bordeaux at the Protestant Hospital and did much to aid the 
Italian movement. She also gave Dr. Hamilton an endowment 
for her training school. 




Dorothy Snell 

Superintendent of Nurses, Queen Helen's Training School in Rome 



Italy 



113 



big Tom cat came quite close, and then she kissed his 
nose and made peace. Now take up your ground, my 
dear Miss Turton, and stick to it. . . . Go on persever- 
ingly and prosper." For all of us these are words of 
really inspired wisdom. If even half of us really succeed 
in living them, success will be a certainty, nay, since our 
leader does live them, even one- third of us, by following 
her, will ensure victory. "Hold your ground, but kiss 
your enemy's nose." A smiling insistence of attitude, 
in other words, whenever certain that the point to be 
gained is undisputably right. 

The first point thus gained, I think, was — screens. 
In our hospitals here such "luxuries" are obtainable 
only (and not always) for the dying. But the first pavil- 
ion now possesses scarlet twill screens, a vivid note in the 
colourless wards, and one which, with the really charming 
green and white frocks of the probationers makes up the 
red, white, and green of the Italian flag. The first 
corollary of screens, systematic washing, is an innovation 
which is almost invariably appreciated. The routine 
evening, "face, hands, and back washing" cause grati- 
tude and surprise. The first night drew forth the remark 
from the Suora in charge, "How quiet the wards were! 
no one seemed to ring. " And the cure amorose of the new 
nurses seem to make even deeper impression on the 
patients than their skill. The real nurse touch, voice, 
and manners are a revelation, even when the words are 
limited by being in an unknown tongue. 

Already patients are leaving off calling perpetually 
for attention; they have learnt that everything will be 
done for them in due time — that ought to be done — and 
without ' ' the hateful tip ! " x 

In 1908, Signora Celli contributed another valuable 
study of hospital conditions and schools for nurses, 

x The British Journal of Nursing, April 30, 1910. 
vol. iv. — 8 



ii4 A History of Nursing 

called "Per le Scuole delle Infermiere" to the Nuova 
Antologia for October. The year of her inquiry 
was 1902. Of 1 24 1 hospitals, 429 were staffed solely 
by secular (untrained) attendants; 112 were nursed 
solely by nuns, while 696 had a mixed staff. [The 
other four were in charge of monks.] The number of 
nurses to this list of hospitals was: secular 8380 
(4613 men and 3767 women), and religious 4313. 
Of these, some seventy were monks and all the rest 
nuns. Signora Celli showed that forty per cent, of 
the personnel in question were in religious orders, 
this percentage having risen by ten per cent, in fifteen 
years. As only ninety-three of these hospitals were 
bound by bequests or conditions, it was clear that 
they preferred the nuns. Their discipline was best; 
they were a superior class of women, and they cost 
the hospital least; even the secular servants cost 
more, while nurses of course were the most expen- 
sive to the administration. 1 She found admirable 
exceptions to the usual low standard of nursing in 
the work of the Sisters of Mercy and the Suore delta 
Sapienza, but emphasised the absolutely unhygienic 
conditions of the Sisters' lives. She referred to a cir- 
cular written by Pope Pius X. in 1906, in which he 
invited nuns to come in turn to a school of instruc- 
tion founded under his auspices in Rome, and coun- 
selled them to lay aside artificial modesty and learn 
to be efficient nurses. Some orders could not, be- 
cause of their rules, follow his counsel, but others 
were doing so, and were taking instruction from the 
professors of the university. Signora Celli showed a 

1 According to an official inquiry of the Minister of the Interior, a 
nurse costs the hospital 505 lire, a servant-nurse 463, a nun 446. 



Italy and Spain 115 

marked reform in the hours of hospital work — her 
earlier statistics had been useful. She advised a 
complete separation of nurses from servants, inde- 
pendence of the ward staff from religious rules, and 
urged the abolition of the male officials who now 
supervise the nurses, and the appointment of trained 
directresses and head nurses, leaving the nuns in full 
charge of the general administration and household 
economy. 

Miss Amy Turton has also treated the question of 
organisation in an open-minded paper, in which she 
said: 

Such facts [the figures cited by Signora Celli] seem to 
prove the folly of even contemplating a general laicisation 
of Italian hospitals, whilst my experience of some fifteen 
years convinces me that, should it be possible, it would 
be the greatest of disasters. For, without going into 
psychological and racial considerations, it cannot be 
denied that hitherto a large proportion of altruism has 
been absorbed by the religious orders, and in consequence 
it would need a generation or two to produce in sufficient 
numbers women who would devote themselves, their 
strength, intelligence, and feeling, to the service of the 
sick, without any impulse given by religious belief. 

Should, therefore, the seemingly impossible happen, 
and Italy exact the suppression of religious nursing orders 
in public hospitals, we should undoubtedly find ourselves 
deprived of the very element we most desire for pupil 
nurses, since the odium attaching to those who replaced 
the Sisters would cause even the most liberal Catholics 
to hesitate before casting their lot in a camp which 
would be designated "atheistic" and "freemasonic." 
The question would inevitably fall into the domain of 
politico-religious conflict, and the cause of nursing 



n6 A History of Nursing 

would be grievously damaged or delayed. We would, 
therefore, proclaim from the beginning our desire that 
the nursing question should remain entirely outside all 
political or religious parties. That our object is solely 
that of helping to provide what modern science recognises 
as needful in nursing patients, either in or out of hospital 
— in other words, the formation of the competent trained 
nurse. Whether she be nun or secular should be a ques- 
tion of individual choice with private patients, and of 
the majority in public hospitals. Briefly, nursing, like 
medicine, should be recognised as a non-confessional 
profession. . . . 

The conclusion to which I come is, that hospitals in 
those towns desirous of bringing nursing up to date 
should start training schools on one of the following 
lines: (a) Hospitals which open training schools to lay 
and religious pupils, (b) Hospitals which confine the 
nursing entirely to a lay staff, retaining the Sisters only 
for economic and spiritual departments. In each type of 
hospital the standard of nursing to be identical, and 
eventually to receive government recognition. In those 
of type (a) the nuns and lay pupils would frequent the 
same two years' courses of lectures, adopt the same 
modern systematisation of ward work, and pass the same 
examination to obtain the same diploma. After two 
years from the opening of these training schools only 
those nurses who gained the diploma, whether nuns or 
lay, would be eligible for the posts of head nurses. In 
both types of hospital the present staff of servant-nurses 
would cease to exist. Those who possessed sufficient 
education and aptitude for the higher training would 
enter as pupil-nurses of the new school. The others 
would compete for places as ward-maids. 1 

The year or more that has elapsed since the auspi- 

x Reports, International Congress of Nurses, London, 1909, p. 53. 




O 



. ' *■ ■ 



Italy and Spain 117 

cious opening of the new school in Rome has brought 
only added encouragement. Its roots seem to be 
well set ; the day is probably ripe for the permanent 
success of a new era in the beautiful hospitals of Italy. 
Already there are intimations that Florence may 
follow the example, and two charming Florentine 
nuns have appeared in the wards cared for by the 
nurses of the Scuola Convitto Regina Elena. 

Spain. — Spain must be numbered among those 
countries where the idea of modern nursing is least 
comprehended, as evidenced by the story of a travel- 
ling American nurse, who was obliged to introduce 
herself as a "doctress" when visiting Spanish hospi- 
tals, as no one knew what a nurse was. Yet there, 
too, the first ground has been broken, and in the 
"Rubio Institute" near Madrid a school for nurses 
was first opened and for a time throve under the 
care of a German Sister, a member of the German 
Nurses' Association. 

The Institute was the creation of Dr. Rubio, who 
was a many-sided genius, far-sighted, benevolent 
and genial, besides being the most progressive and 
scientific surgeon in Spain. He effected a revolution 
in Spanish surgery, and was the first to perform there 
many well-known and important operations. The 
Institute, for which he obtained funds by a public 
appeal, is a unique establishment, being actually a 
small republic in its government. All the beds are free, 
and the patients' friends and relatives have the stand- 
ing of guests. While the Institute beds are largely 
surgical, a circle of "polyclinics" attached to it give 
general training as well as study of varied specialties. 



n8 A History of Nursing 

In 1896, Dr. Rubio first undertook developing a 
school for nurses, and named it after St. Elizabeth 
of Thuringia. Genius though he was, the rules and 
organisation of this school were as extraordinary as 
could be imagined. The pupils first taken were 
from a lowly and uneducated element, and, as there 
was no compulsory free schooling to be had, they 
were positively illiterate. Undismayed by this, 
however, his intention, buoyed by enthusiasm, was 
to give them a thorough professional training in two 
years' time. Perhaps to banish all coquetry from 
their minds, perhaps also from motives of convenience 
and cleanliness, the nurses were made as hideous as 
possible. Their hair was shaved off, and dark purple 
woollen hoods, made with earflaps and trimmed with 
yellow frills, were set upon their heads. The uniform 
was a dark blue striped cotton of shapeless cut, and 
on the breast was worn a large cross in yellow linen 
with the name of the school on it in purple letters. 
A white apron was worn with it, and winter and 
summer the nurses had no stockings, only sandals 
on their feet. 

The rules at the outset were exceedingly strict. 
The pupils were neither allowed to make nor receive 
visits, and the plan was to keep them so busy that 
they should have no time for relaxation, which might 
permit of gossip, or even of thought. Besides the 
nursing, they performed all the work of the place, 
cooking, laundering, and scrubbing. In order that 
they should not become familiar with the patients, 
their work was changed every eight days in a fixed 
routine: kitchen, laundry, housework, women's 
ward, men's ward, eye clinic, ear clinic, general 



Italy and Spain 119 

clinic, operating rooms, and then beginning again 
with the kitchen. Even the directress, who, at first, 
was selected from among the staff, was changed in 
the same way every eight days for some time, but, 
the impossibility of this arrangement doubtless be- 
coming apparent, she was left for one month, then 
for three, and later for a whole year, in her post. 

The first directress to receive a salary was Donna 
Socorro Galan, who brought about considerable im- 
provement in the domestic management. To her it 
was due that cooks and laundresses were installed 
and the nurses relieved of so much of the labour. 
She remained for about six years in her position, and 
during the latter part of her administration the train- 
ing period was lengthened to three years and a sum 
of money awarded to pupils in the final year if their 
conduct had been meritorious. The hours, however, 
retained their mediaeval and inhuman stamp. The 
nurses were on duty from 5 a.m. until 9, 10, or 1 1 p.m. 
with scarcely time enough even to eat their meals 
in peace, while night duty, falling every third or 
fourth night, gave a stretch of from thirty-eight to 
forty hours' continuous service. In addition to this, 
if it was thought necessary to discipline or punish a 
nurse, it was customary to extend this service even 
further, or send her to bed without food. In all this 
grotesque arrangement there was no intention at all 
of cruelty, but, on the contrary, the most benevolent 
disposition. It was simply believed to be the proper 
thing. How the nurses survived is a miracle, and 
that the patients did is even more remarkable, for 
the wards were always full of fresh operation cases. 

In 1 910, the Director of the Institute was Dr. Gu- 



120 A History of Nursing 

tierrez, physician to the Queen of Spain, and under 
his rule (through the Queen's influence one can hardly 
doubt, though there is no evidence) the harsh regime 
was mitigated and an attempt made to introduce 
modern methods. Dr. Gutierrez now called to the 
position of Directress a German lady resident in 
Spain, who had taught in Madrid for a number 
of years and had also taken the Victoria House 
training in her native city, Berlin, — Sister Marie 
Zomak. Before entering upon the difficult work 
of reorganisation, Sister Marie went to Bordeaux 
to stay with Dr. Hamilton and Miss Elston and learn 
of their experience and methods in an environment 
similar, in some respects, to that she was about to 
enter. She wrought great changes in the Institute 
Rubio. The. hours of duty were remodelled, night 
duty set for two weeks at once, with eight hours' 
sleep for night nurses, and a day off at its termination. 
The purple hoods were thrown away, and the pupils' 
hair allowed to grow, white linen caps set on it, and 
stockings put on their cold bare legs. A certain 
amount of freedom under proper chaperonage was 
provided, and visits from relatives allowed. 

Of great importance was the perfected instruction. 
Heretofore the training had all been practical, but 
now theoretical teaching was given by Dr. Mut, who 
not only devoted himself with unselfish energy and 
without remuneration to his class work, but was also 
an excellent and successful teacher. 

Such changes could hardly take place in a conserv- 
ative country without exciting intense disapproval, 
and so it was in the Institute Rubio. All the more 
conventional elements, including ladies who had taken 




a, 



a 

O 

O 



Italy and Spain 121 

a philanthropic interest in the work, believed that 
destruction was at hand, and Sister Marie passed 
through a difficult time There was one episode, 
indeed, which left her without any nurses except 
two who remained loyal, but at that critical moment 
the whole medical staff rallied to her side, and offered 
their services to take any necessary part of the care 
of patients. Sister Marie was on duty day and night 
for some weeks, and not a patient suffered, nor were 
operations delayed. A truce then followed for the 
summer months, and there we leave her, knowing 
that progress is an uphill path, leading through thorns 
and over pitfalls. 



CHAPTER IV 

NURSING IN NEW CONTINENTS 

Collaborators: M. Louise Lyman, Canada; Alice R» 
Macdonald and Ellen Julia Gould, Australia; 
Hester Maclean, New Zealand; Margaret 
Breay, Africa. 

Canada. — In making a study of hospital and nurs- 
ing conditions throughout Canada, we are confronted 
with a great difficulty — the lack of a general scheme of 
vital statistics and reports. Statistics are provincial 
records only, and are mostly recent and incomplete. 
We have, to refer to, the decennial census which 
takes us back to 1901 There is no Bureau of Public 
Health, and the health agencies of the Federal 
Government are scattered in the various departments 
so that information relative to hospital or nursing 
matter can be obtained only from individual sources 
and research. 

In the earliest days of her history and throughout 
the French regime (1 535-1 759) , Canada was indebted 
wholly to the religious orders which came out from 
France for the establishment of hospitals and the 
care of the sick in their homes. Some record of the 
heroic and perilous lives of the hospitalises has 
already been made in our first volume. 

122 



In New Continents 123 

The early French hospitals of which we find au- 
thentic records are, in chronological order, as follows: 

St. Jean de Dieu, founded in 1629, or shortly after, 
at Port Royal in Acadia (now Annapolis) ; no longer 
in existence. L'Hdtel Dieu du Precieux Sang, at 
Quebec, founded in 1637 by the Jesuits and taken 
charge of later by the Augustinian nuns from Dieppe, 
as related, 1 is still in existence on its original site. 
L' Hotel Dieu de Saint- Joseph of Montreal, founded 
by Mile. Mance in 1642 and completed in 1644; still 
in existence. The Hospital for Hurons, founded in 
Sault Ste. Marie in 1642 by the Jesuits and nursed 
by them until it was burned by the Iroquois in 1644. 
L'Hopital General in Montreal, dating from 1688, 
founded by the Sulpiciens and nursed by lay 
brothers until 1745, when a new order, called the 
Grey Nuns, founded by Mme. d'Youville, took 
charge of the nursing; still in existence. L'Hopital 
General of Quebec, built in 1621 by the Recollets 
as a monastery and purchased from them by Mon- 
seigneur St. Vallier for a hospital; given into charge 
of Sisters from the Hotel Dieu of Quebec in 1692; 
figured in the siege of the city in 1759, and still in 
existence. Two that have ceased to exist are the 
Hotel Dieu at Three Rivers, founded in 1697, by 
St. Vallier and given to the Ursulines, and a hospital 
at the Fort of Louisburg, founded in 17 16 or soon 
after by five lay-brothers of Charite de St. Jean de 
Dieu, who filled the offices of Superior, surgeon, 
dispenser, nurse, and chaplain, respectively. The 
annals of all of them are replete with accounts of 
conflagrations, epidemics, and sieges. The Hotel 

1 A History of Nursing, Vol. I., p. 369. 



124 A History of Nursing 

Dieu at Quebec was twice burned, the last time in 
1755, when nearly all its original documents were 
destroyed. The Montreal Hotel Dieu was destroyed 
by fire in 1695, 1721, and 1734. The General Hos- 
pital of the Grey Nuns in Montreal was burned in 
1745 and 1765, and the Hotel Dieu at Three Rivers 
in 1806. 

Throughout the ravages of the Indians, the con- 
stant warfare between the French and British, and 
the many epidemics and plagues to which Canada 
fell heir, these hospitals sheltered and cared for 
the wounded and sick. Later, when, in 1775, the 
Americans invaded Canada they figured as military 
hospitals and barracks. 

The hospitals under religious orders in the Domin- 
ion now number about eighty-four, of which forty- 
four are in Quebec Province, For the most part, 
they continue along the lines of their original, con- 
servative policies, yet the influence of the modern 
spirit has not quite passed them by, for, within the 
past decade, training schools for nurses have been 
started in many of the Sisters' institutions and ex- 
cellent nurses are sent forth from under their aus- 
pices. The religious orders have greatly increased in 
numbers in Canada, and their monasteries and 
hospitals multiply as the population and opportu- 
nities for them increase. It is, therefore, hardly 
possible to obtain complete statements as to these 
institutions and schools, but we shall presently make 
some record of the most important. 

With the settlement by the British, hospitals were 
established under civil or military control, in the 
more thickly populated districts, at shipping ports 



In New Continents 125 

and in towns along the waterways. Gradually the 
hospital idea grew until now there are found hospitals 
from coast to coast, not only in the cities and towns, 
but throughout the country and sparsely populated 
districts, along lines of railway construction and 
in remote mining camps far north. Some three 
hundred or more, exclusive of military, private, and 
special institutions, exist in Canada, at our writing 
in 191 1 , while the estimated total number of hospital 
beds is fifty thousand. They are supported by 
public and private subscriptions, aided by provincial 
or municipal or county grants. Some are entirely 
maintained by the province or the municipality. 
Comparatively few have endowments. 

A brief account of the more prominent hospitals 
and training schools is all that we may attempt. 

The first hospital, under lay management, was 
founded in Halifax, in 1750. It stood back of the 
present site of Government House, and, in 1766, 
was granted to the city as an almshouse and used 
as such until 1800, when it was torn down. 

The first training school in Canada, that of St. 
Catharine's, has been briefly described. 1 It was 
later given the name of its founder and called the 
Mack Training School. This, the oldest school for 
nurses in Canada, and one of the first on the conti- 
nent, has been in existence continuously for thirty- 
seven years, and is to-day one of the best known 
of the smaller training schools. It has an atmosphere 
of distinction and charm and is in every way a place 
of dignified traditions. The early graduates were 

1 A History of Nursing, Vol. II., pp. 354~355- 



126 A History of Nursing 

called "Sister'* and wore an outdoor uniform, but 
both customs were discarded some years ago. From 
the beginning the nurses had a separate home, and 
were never housed in the hospital itself. 

The first attempt to introduce trained nursing 
into a large civil hospital was made in Montreal. 
Quebec Province boasts in the Montreal General Hos- 
pital the most important, historically, in Canada. 
After the war of 1812-1814, and after disbandment 
of the armies in 181 5, when Waterloo broke the power 
of Napoleon and settled the peace of Europe, there 
was a great influx of emigrants into Canada from 
Great Britain and Ireland. The winter closing of 
the great waterways prevented new arrivals from 
going far west. Quebec, Montreal, and Kingston 
were crowded with emigrants, starving, sick, and with 
no means of support. To cope with the distress, the 
Montreal Female Benevolent Society was founded 
in 1 8 16. Through its efforts, in that year, a four- 
room house was taken on Chaboillez Square and was 
called "The House of Recovery.' ' The first phy- 
sician in charge was Dr. T. P. Blackwood, a retired 
army surgeon. In 18 18, a large house, capable of 
accommodating twenty-four patients, was hired on 
the north side of Craig Street, near Bleury, and was 
called the "Montreal General Hospital." In 1820, 
the land on which the front of the present hospital 
stands was bought. (It was then called Marshall's 
Nursery.) The corner-stone was laid June 6, 1821, 
with Masonic honours, and the following year the 
hospital was ready for use with accommodation 
for seventy patients. In January, 1823, His 
Majesty George IV. granted a Royal Charter. In 



In New Continents 127 

1866, the land opposite the hospital was bought and 
the old buildings on it were removed. 1 

In 1822, a school of medicine was organised in 
connection with the hospital and called the Montreal 
Medical Institution. In 1828, this became the 
Faculty of Medicine of McGill University. This was 
the beginning of the university, and for some time 
the medical faculty was the only faculty, was, in fact, 
McGill University. The General Hospital, there- 
fore, is intimately connected with and is virtually 
responsible for the establishment of the university. 

In 1 83 1, Montreal had thirty thousand inhabitants. 
That year cholera carried off, in three months, one- 
tenth of the population, and it was a busy time for 
the hospital. In 1869, 160 cases of smallpox were 
treated there. 

In an address delivered to the Montreal General 
Hospital Nurses' Club, December 6, 1905, Dr. F. 
T. Sheppard, dean of the medical faculty of McGill 
University, described thus the wards and nursing as 
they were in 1867: 

The wards were small and rather untidy, the nurses 
were Sarah Gamps. Good creatures and motherly souls, 
some, — all uneducated. Many looked upon the wine 
(or brandy) when it was red. ... In those days, it was 
with the greatest difficulty patients could be induced to 
go into a hospital. It was the popular belief that if they 
went they would never come out alive. . . . No records 
were kept. The clinical thermometer had not come 
into use; the patients had to look after themselves; fresh 
air was not thought necessary. Armies of rats disported 

1 The Canadian Nurse, March, 1906. "Montreal General Hospital 
A Short Historical Retrospect." F. T. Sheppard, M.D. 



128 A History of Nursing 

themselves about the wards. . . . Instruments were 
looked after by a man who assisted in the operating room 
and at post-mortems in the dead-house. Nothing was 
known of sepsis or antisepsis. Surgeons operated with 
dirty instruments and septic hands and wore coats which 
had for years been baptised with the blood of victims. 

In 1875, the Committee of Management decided 
to make a change for the better, and in the autumn 
of that year Miss Nightingale, who was, of course, 
consulted, and who entered most warmly into the 
project, arranged for a lady superintendent, Miss 
Machen ( a Canadian), one Sister, and four trained 
nurses from the Nightingale school to go to Canada, 
and they entered upon their duties with the good 
wishes of the public and the hospital authorities. 
The results attending this enterprise were at first 
satisfactory, not only in the superior quality of the 
scientific nursing, but in the influence and example 
exercised by gentlewomen. Their moral influence 
and 'dignified presence in such an undesirable com- 
munity were not the least of the benefits conferred. 
But, unfortunately, this advanced innovation was 
doomed to failure, and, after difficulties, jealousies, 
restraint, and much unjust public criticism, the hope 
of establishing a training school was abandoned, 
and, to the regret of their friends, the Nightingale 
nurses returned to England. Possibly, had they 
lived down the jarring notes and shown a little more 
tact in dealing with a difficult problem, the result 
of their advent might have spelled success instead of 
failure. 

Naturally, nursing affairs then took a retrograde 
movement. After this attempt a matron who was 



In New Continents 129 

not a nurse was appointed to take charge of the 
hospital, and Miss Anna Maxwell (later of the Pres- 
byterian Hospital, New York) was placed in charge 
of the nursing department. However, this arrange- 
ment, never satisfactory, broke down. Miss Max- 
well, finding herself thwarted in her work, returned 
to the States, and the matron took entire charge for 
a period of fully ten years, when, in 1889, she retired 
because of ill health. 

Under pressure from various sources the Commit- 
tee of Management realised that they had reached a 
momentous period in the history of the hospital, 
and that, in order to keep in line with modern pro- 
gress, it was necessary that the nursing be taken out 
of the hands of the ignorant and uneducated and 
given over to intelligent and trained women. Ap- 
plications were called for from both England and the 
United States for a lady superintendent — a graduate 
from a training school in good standing. Many 
experienced applicants for the position declined to 
accept it when they fully understood the overwhelm- 
ing difficulties to be combated, but it was finally 
undertaken in January, 1890, by Miss Norah Living- 
ston, an American, who had recently graduated from 
the training school of the New York Hospital and 
who brought with her two assistants, graduates from 
her own school. 

In December of that year the school was formally 
opened by His Excellency, Lord Stanley of Preston. 
The nursing department was soon in good running 
order and the public recognised and supported the 
nursing reform. In 1 891 , a class of five nurses gradu- 
ated. Their names were Ellen Chapman, Georgina 

VOL. IV. — 



130 A History of Nursing 

Carroll, Jean Preston, Julia English, and Christine 
Mackay. In 1906, a preliminary course for pro- 
bationers was established, one of the graduates 
holding the diploma of Teachers College, Columbia 
University, New York, being appointed instructor. 

The next large hospital to reform its nursing was 
in another and neighbouring province, Ontario. The 
largest hospital in Canada is the Toronto General, 
containing four hundred beds. Its history briefly 
is as follows: In 18 19 certain lands in York (which in 
1834 became Toronto) were granted by the Crown, 
in trust to four persons for hospital and park pur- 
poses. In that year appeared in the Upper Canada 
Gazette the following notice : 

Proposals for building by contract a Brick Hospital 
in the town of York will be received at the Post Office, by 
William Allan, Esq., where a Plan, Elevation and par- 
ticular description of the intended Building may be seen 
and any information respecting it obtained. Proposals 
to be given in within one month from this date. 

York, November 24, 18 19. 

The original York hospital was built on King, near 
John Street. In 1832, it was described as "in success- 
ful operation and affording to the students daily 
opportunities of observing diseases and their treat- 
ment." In 1 847, an Act was passed incorporating the 
Trustees of the Toronto General Hospital. Shortly 
after 1847, the present main building on Gerrard 
Street was erected. To it have subsequently been 
added several additions. A magnificent new build- 
ing being erected in the centre of the city, (191 2) 
is to supersede the present building 



In New Continents 131 

The training school that it was proposed to es- 
tablish had, like that of the Montreal General, an 
initial period of distress. In the Canada Lancet, 
July 31, 1877, we read: 

It is proposed to establish a training school for nurses 
in connection with the General Hospital, Toronto. Miss 
Goldie, Lady Superintendent of the hospital, will assume 
the management. She has had considerable experience 
in the Franco- Prussian War and in British and Conti- 
nental hospitals, and is, therefore, eminently qualified for 
such an undertaking. It is proposed to take in about 
twenty young women, and distribute them about the 
wards of the hospital, where they will have to discharge 
the duties of the nurses already in the place. The period 
of residence will be about six months, and the fees will be 
about fifty dollars for the period, including board and 
lodging. Appropriate lectures will be given by medical 
gentlemen of the city. Those wishing to enter should 
apply at once to Miss Goldie. 

It was not, however, until four years later, that 
the training school in connection with this hospital 
was really established. The nurses employed were 
women of the type found in hospitals everywhere 
prior to the establishment of training schools. They 
received nine dollars a month with board, lodging, 
and a daily allowance of beer. They occupied bed- 
rooms opening into the wards of which they had 
charge, and each nurse carried her knife, fork, and 
spoon in her pocket. 

The successful changes which had been introduced 
into Bellevue, and into the Massachusetts General, 
encouraged the Toronto authorities in deciding 



132 A History of Nursing 

to organise a school for nurses, and in April, 1881, 
the entire nursing staff, then consisting of seven- 
teen women, was invited to be present at a meet- 
ing held in the amphitheatre. Addresses were 
delivered, and the nurses were told that a training 
school was to be opened. They were offered the 
privilege of being enrolled as pupils in training upon 
the following conditions: They were expected to 
agree to remain two full years in the hospital and at 
the expiration of that time to pass an oral examina- 
tion before a board of examiners. Those who ful- 
filled this condition were promised a certificate of 
qualification in nursing, signed by the authorities 
and by the examiners, and a silver badge. Only 
five of those present agreed to accept the new state 
of things, and at the expiration of two years (1883) 
these pioneers received the certificate and badge of 
the new school. 

After eight years in the hospital, Miss Goldie re- 
tired and was succeeded by Mrs. Fulford (nee Starry), 
a graduate of an English hospital. This lady was 
succeeded in six months by Miss Lucy Pickett, a 
graduate of the Massachusetts General, who in her 
turn resigned after eight months' incumbency. To 
the initiated these brief, quickly relinquished efforts 
to guide the helm are significant of troublous times, 
of authority helpless and defied, and of insubordina- 
tion where discipline should be. The organisation 
of the training school was still most incomplete. 
The nurses occupied rooms situated in various parts 
of the hospital; slept on straw beds; their dining-room 
was in the basement, and they not only served the 
meals in the wards, but washed the dishes. As yet 



In New Continents 133 

they were little advanced beyond the servant class, 
and their instruction was elementary. At this point 
the real organisation of nursing was taken up and 
with undeviating and unremitting patience carried 
on until fully and roundly developed. 

In 1882, Miss Mary A. Snively, a Canadian woman 
with teacher's training, went to Bellevue Hospital 
from the little town of St. Catherine's. Miss Perkins 
was then at the head of the Bellevue school, and 
when, in 1884, the Toronto hospital trustees applied 
to her for a superintendent of nurses, she, with that 
consummate skill in character-reading, and in select- 
ing the right woman for a post which was her most 
valuable asset, at once sent them Miss Snively, who 
had just finished her course. For twenty-five years 
of unbroken service Miss Snively presided over the 
hospital nursing and the training school. At once 
dignified and genial, with patience enough to wait a 
quarter century for the full fruition of her labours, 
diplomatic and astute in maintaining her position 
against difficulties, she, little by little, reorganised 
the school on modern lines. 

In 1910, after twenty-six years of service, Miss 
Snively retired full of honours. She was succeeded 
by Miss Stewart, a graduate of the Johns Hopkins. 

The history of these two women, Miss Snively 
and Miss Livingston (the latter at the end of 191 1 
still in her post) , is the history of nursing in Canada. 
Their graduates have gone forth from their hands into 
every corner of the Dominion, bui ding, developing, 
reforming, carrying the traditions and atmosphere of 
the schools in which they were trained. To Miss 
Livingston is due not only the efficiency of the 



134 A History of Nursing 

nursing department of the Montreal General, but 
the high tone and standard of nursing to-day in many- 
parts of Canada. Miss Snively, strongly social by 
nature, has been foremost always in public move- 
ments, in nursing organisation, in the superintend- 
ents' conventions, in committee work, and in educa- 
tional propaganda. Hers is the credit of having led 
Canadian nurses in national and international rela- 
tions and of having cherished the international spirit. 
She rightly regarded the national associations of 
Canadian nurses, and their affiliation with those of 
other countries, as the crowning work of her nursing 
career. 

Having followed the leading figures in the early 
transformation of Canadian nursing, we return to a 
brief summary of the conditions in the various pro- 
vinces, taken serially, and beginning with Nova 
Scotia. What is now the Victoria General in Halifax 
was formerly a military hospital founded by the 
Imperial Government. In 1880, the buildings were 
taken over by the local authorities and changed into 
a general hospital under the name of "Provincial 
and City Hospital" for the Province of Nova Scotia 
and Cape Breton. In 1896 and later, large wings 
and buildings were added. Its present name was 
adopted in honour of Queen Victoria's Jubilee. It 
is supported by the government of Nova Scotia and 
accommodates two hundred patients. Its training 
school for nurses was established by the Executive 
Council of Nova Scotia in 1892. Only natives of 
Nova Scotia, men as well as women, are admitted 
as pupils. The men take the same course as the 
women, with the exception of two specialties, and 



In New Continents 135 

some of them have remained for years in the same 
position. The training of men is regarded here as 
successful. The school had, in 191 1, a roll of forty- 
five students, seven of whom were men. 

The Aberdeen Hospital in New Glasgow has its 
nurses' school; Charlottetown has a training school 
in the Prince Edward Island General Hospital; St. 
John's, New Brunswick, has one organised in 1888. 
Fredericton was one year earlier with its school 

At Kingston, in 1812, a few citizens banded them- 
selves together under the name of the Kingston Com- 
passionate Society with the object of relieving the 
distress and sufferings of emigrants. The society's 
work increased, and in 182 1 was taken over by the 
Female Benevolent Association, which, in 1833, ap- 
pealed to the Legislature of Upper Canada and ob- 
tained a grant toward the erection of a hospital. 
The building was completed in 1834, Dut owing 
to lack of means the interior was unfinished until 
1837 when a further grant was received from the 
government. 

During the rebellion of 1837-8, on the advice of 
Colonel Bonnycastle the recently completed build- 
ing was used for military purposes from May, 1838, 
to June, 1839. In 1841 the building was changed 
to some extent and the United Legislature of Canada 
met there until 1844. In that year the Female 
Benevolent Association received permission to send 
their sick poor to the hospital, and a small grant was 
made by the legislature for maintenance. In 1888, a 
training school was organised by the late Dr. Fen wick 
in connection with the hospital. Four nurses com- 
posed the first staff, three of whom graduated. 



136 A History of Nursing 

The horrors of 1847, caused by the failure of the 
potato crop, frightful famine, and the ensuing typhus 
which made Ireland desolate, can never be forgotten. 
Hundreds of thousands fled for refuge to America, 
many died on shipboard, whole others landed on the 
shores of Canada only to succumb to the pestilence. 
Thousands died at Grosse Isle, at Quebec, and at 
every port along the waterways. The hospitals were 
over-filled and temporary sheds were erected to 
shelter the victims. In Quebec a private hospital was 
opened by Drs. Douglas and Racey, who had an- 
ticipated the outbreak. It was on the Beauport 
Beach and accommodated masters of vessels and 
cabin passengers who objected to going into crowded 
public hospitals. 

During the outbreak this place became over- 
crowded and consequently the "dwelling house and 
premises of the old breweries" at Beauport were 
leased. One hundred and sixty-five cases of typhus 
were cared for in these buildings. 

On June 17th, at Point St. Charles, near Montreal, 
hundreds were dying unaided. Three sheds two 
hundred feet long and fifty feet wide were built, and 
the Grey Nuns went to aid the sufferers. In the 
open space between the sheds lay the inanimate 
forms of men, women, and children. More arrived 
day by day. Death was there in its most appalling 
form. On June 24, two young nuns were stricken 
with ship-fever and more followed hourly until thirty 
of them lay at the point of death. Seven died, while 
those remaining, overwhelmed with exhaustion, 
were obliged to withdraw. Then the Sisters of St. 
Joseph from the Hotel Dieu tcok their places. In 



In New Continents 137 

September the Grey Nuns resumed their heroic task 
at the sheds and continued their charitable labours 
not only during 1847-48, but also later, when, in 
1849, cholera replaced the typhus fever. 

At this time the only route for the transportation 
of immigrants to the Canadian West was by Ottawa 
through the Rideau Canal, which had been opened 
in 1832. Over three thousand emigrants reached 
Bytown (now Ottawa), and with them the typhus. 
The first patients were taken to the Grey Nuns' 
hospital. Later, the government built sheds for 
their reception. The nuns continued to care for the 
fever-stricken, and, before the erection of the special 
sheds, any improvised shelter such as upturned 
boats was utilised. The County of Carleton General 
Protestant Hospital was the outcome of the fever 
epidemic. Many desired a hospital under the con- 
trol of the public, to be supported by public sub- 
scription. This resulted in the formation of a 
board, whose efforts were rewarded in 1850 by the 
erection of the stone building on the lot at the north- 
west corner of Rideau and Wurtemberg streets. In 
1854, Bytown became Ottawa. The original build- 
ing, until 1875, served as the General Hospital 
and was then used for contagious cases, until 1903, 
when the city opened a new Isolation Hospital. In 
1907, the old building was torn down. 

In 1898, the Grey Nuns established a training 
school for lay nurses in the Ottawa General Hospital. 
The superintendent of nurses for some years was 
Sister Mary Alice, trained in Lowell, Massachusetts, 
at St. John's. Ten graduate nurses were placed 
in charge of wards, and affiliation has now been 



138 A History of Nursing 

effected with the Maternity and Isolation hospitals, 
thus securing the pupils in their three years' course, 
a full variety of services. This was the first of a 
number of training schools now managed by the 
Grey Nuns, of which they are justly proud. 

In Montreal an institution of the first importance 
from a medical and nursing standpoint is the Royal 
Victoria, a general hospital beautifully situated on the 
slope of Mount Royal, overlooking the city. It was 
established through the munificence of two Canadian 
peers, Lord Mount Stephen and Lord Strathcona, 
each of whom gave in all a round million of dollars 
toward it. The building was opened in 1894, when 
the training school was also started. To open and 
develop it on the most highly advanced plane pos- 
sible, Miss Edith Draper, of a Canadian family dis- 
tinguished for intellectual eminence, a Bellevue 
graduate and old friend of Miss Snively and Miss 
Hampton, was called from the position she was then 
filling as superintendent of the Illinois training 
school. The Royal Victoria school for nurses soon 
came to rank among the best in America. In 1906, 
a modified preliminary course was started which 
includes a domestic science course. The residence 
for nurses was opened in 1907. 

Montreal has a splendid modern Maternity Hos- 
pital, affiliated with McGill University, where pupils 
of the Royal Victoria and the General schools obtain 
their obstetric training. 

The Sisters of St. Joseph, who have served the 
H6tel-Dieu of Montreal since 1659, have seen a won- 
derful growth in their hospital, whose early days were 
so dramatic. In 1859 it removed from the original 



In New Continents 139 

site in St. Paul Street to Pine Avenue, and the Sisters 
now preside over a fine modern building with a front- 
age of 650 feet, covering two city squares, and con- 
taining nearly three hundred beds. The wards are 
spacious and airy, with modern equipment. The 
beds are surrounded by white linen curtains. The 
private wards are large and perfectly equipped for 
therapeutic bath treatment. Operating rooms and 
fittings leave nothing to be desired. The dispensing 
is performed entirely by the nuns. In the large and 
beautifully arranged pharmacy a Sister is in charge 
who teaches her skill to the others, while every ward 
has a nun in charge of medicines and drugs, whose 
duty it is to compound, in the pharmacy, all the pre- 
scriptions and disinfectants needed in her ward, and 
to see to their administration and use. The electrical 
department of the hospital is celebrated for its com- 
pleteness, and was the gift of Dr. Desloges, the 
Sisters supplying the rooms and assistance. A 
training school for lay nurses was opened in 1902, 
at the instance of Dr. St. Jacques. Beginning with 
five pupils, there were, in 191 1 , twenty taking a three 
years' course. The lectures and demonstrations are 
given by the visiting physicians; the nuns, as staff 
and supervising nurses, giving the practical teaching. 
The Sisters, with their novices, are nearly all on duty 
in the wards. They do no regular outside nursing, 
but are frequently accorded permission to leave the 
hospital to perform works of mercy. As these 
Sisters are strictly cloistered, they never leave the 
grounds without the consent of the Archbishop. In 
Montreal there are also several smaller training 
schools. In the old city of Quebec is Jeffrey Hale's 



140 A History of Nursing 

Hospital, dating from 1864. It is a large and well« 
equipped modern building,with a good training school. 

Excellent schools for nurses exist in connection 
with general hospitals in Ottawa, Hamilton, London, 
Guelph, and many other Ontario towns, of which, 
did space permit, interesting details might be given. 
In Toronto, the Sisters of St. Joseph have had train- 
ing work in hand longer than those in Montreal 
(for it is not clear that the orders are the same, 
though with the same name), as, at St. Michael's, 
it was begun at the opening of the hospital in 1892. 
The course is three years' medical and surgical work, 
with a three months' preliminary course. The Sisters 
supervise in wards and operating rooms. 

Manitoba has at least thirty hospitals and eight 
training schools. The pioneer hospital of the West 
is the St. Boniface General. On April, 25, 1844, 
three Grey Nuns left Montreal in canoes for the far- 
off Red River settlement. They arrived at St. 
Boniface, opposite Winnipeg, on the 21st of June 
and there immediately established the first hospital 
in the West, which has grown to accommodate four 
hundred inmates. A training school was established 
in 1890, with a course of two and a half years. 

The most important Western hospital, however, 
is the Winnipeg General. In 1871, after the collapse 
of the rebellion, the little colony of Fort Garry en- 
joyed a considerable boom, and many volunteers 
who had come up from the East beat their swords 
into ploughshares and remained as colonists. Other 
immigrants came in over the Dawson route, or by 
river and cart from St. Paul. Houses were few and 
over-crowded, and, when sickness broke out, condi- 



In New Continents 141 

tions were such as to render immediate action neces- 
sary. A meeting was called, a board of health 
formed, and steps taken to begin hospital work im- 
mediately. A one-story frame house was the best 
place that could be secured, and this became the first 
general hospital of Winnipeg. It was not destined to 
become a settled institution without its full share of 
the vicissitudes of the pioneer. For ten years it 
moved from place to place, doing the best possible 
work under the worst possible conditions. The 
present location, reached in 1883, was the eighth 
occupied. By this time the construction of the 
Canadian Pacific Railway was well under way, and a 
large up-to-date hospital was necessary. This was 
erected and on March 13, 1884, was opened. In 
1899, a large Jubilee wing was added to the hospi- 
tal. In 1909, the hospital accommodated three 
hundred and fifty patients. 1 

The training school was organised in 1887, and has 
set the standard of nursing west of the Great Lakes. 
A nurses' home was built in 1888. Here the nurses 
also enjoy a summer cottage on the lake, the gift of 
friends in the hospital administration. We believe 
this is the only instance in Canada where provision 
for nurses during vacation is made by an institution. 
The hospital retains a large staff of permanent head- 
nurses and employs a nurse as social worker. 

Alberta and Saskatchewan, together, have about 
forty hospitals, some of which have between fifty and 
one hundred beds. Twelve of these institutions have 
training schools. In the Yukon, with its frontier 

'"The Winnipeg General Hospital," by Ethel Johns; The Cana- 
dian Nurse, June, 1909, p. 298 et sea. 



142 A History of Nursing 

life, nursing may be seen in some of its most pictur- 
esque aspects. There are five hospitals in the 
territory, some of which are nursed by Sisters. 

British Columbia has fifty-seven hospitals with six 
training schools, of which the oldest and best known 
is the Royal Jubilee in Victoria, with one hundred 
beds, founded in 1890. Its school was established 
when the hospital was built. The Vancouver Gen- 
eral is the largest and most important in the province, 
with two hundred and fifty beds. In all these hos- 
pitals the nursing staff is ample, numbering, on an 
average, one nurse to three patients. In lumbering 
and mining districts are hospitals controlled by mills 
or mining interests. Here and there, nurses are 
found in tents and shacks caring for the sick, while 
awaiting the erection of more permanent quarters. 
British Columbia is so new that the population far 
exceeds the housing accommodation. 

The Columbia Coast Mission, established in 1905 
by the Rev. John Antle, has three hospitals for min- 
ing and logging camps, of which there are thirty scat- 
tered along one hundred miles of island- studded 
coast. Patients are brought by the hospital steam- 
boat Columbia, and sometimes in small open boats. 
At each hospital are a resident surgeon, a head 
nurse, an assistant nurse, and a " kitchen-helper," 
usually a Japanese. Here a medical officer may be 
found hauling baggage up-stairs, fetching hot water, 
or even helping to cook. Strict discipline, however, 
prevails. Space fails to permit of a fuller account of 
the simple though arduous life led by cultured 
workers in this mission, to which we owe so much in 
helping to develop the resources of the country. 



In New Continents H3 

Hospitals for Children. — Halifax and Montreal 
have institutions for children ; the former, founded 
in 1909, with Miss Fraser from the Sick Children's 
Hospital of Toronto. The Children's Memorial, in 
Montreal, is a good example of affiliation, for its 
nurses pass through other hospitals for obstetrics 
and gynecology. The Foundling and Baby Hospital 
in this city carries on a milk depot, opened in 1901. 

The most important Canadian hospital for child- 
ren, and one of the most perfect of its kind in the 
world, is in Toronto. Established in 1875, its training 
school was opened in 1886 and has become one of 
the most thorough and progressive on the continent. 
Its ratio of one hundred and sixty little patients 
and sixty pupil nurses, as well as a supervising staff, 
shows that it is well cared for. In 1897, Miss Louise 
C. Brent, a Canadian graduate of the Brooklyn 
City, was placed at the head of the hospital and 
all its departments, and under her rule both school 
and wards have become models. The hospital owes 
much to the devotion of Mr. J. Ross Robertson, presi- 
dent of the board of governors, through whose gener- 
osity a magnificent residence for nurses was built in 
1906. A preliminary course for the probationers was 
then established, with trained teachers and lecturers. 
Especial emphasis is given to domestic science. The 
course is four months long and is included in the 
three years' term. During training the pupils are 
sent to affiliated hospitals for obstetrics and gyne- 
cology. Some two hundred and fifty nurses have 
gone forth from this school, many to take posi- 
tions as the heads of hospitals. Mr. Robertson, 
whose benevolence extends to the whole nursing 



144 A History of Nursing 

profession, has made it one of his amusements to 
collect a complete library of nursing literature in the 
nurses' home. He may truly be called the father of 
Canadian nursing affairs. 

During the summer months, all cases of surgical 
tuberculosis, and as many others as possible, are 
transferred to the Lakeside Home of one hundred and 
twenty -five beds, a beautiful spot on an island in the 
lake. 

The Nurses Alumnae Association, organised in 
1903, formed in 1909 the Heather Club, with the 
aim of giving voluntary care to tuberculous children. 
Mr. Robertson gave the club a pavilion on the 
grounds of the Lakeside Home, and during the first 
year over thirty children were cared for by the vol- 
untary work of the members, each nurse giving two 
weeks of time. The pavilion then grew to accom- 
modate fifty, and two permanent nurses were taken 
on, who accept a purely nominal salary as a contri- 
bution to the cause, while the voluntary work 
continues as before. 

In the great West, Winnipeg has the only hospital 
for children, founded first in temporary quarters, 
with twenty-two beds, in 1909, then given a new 
building of three times that capacity by popular 
subscription. To organise its training school in 
191 1 came a nurse from Guy's, in London, Miss 
Elsie Fraser. 

State Hospitals. — I. There is a system of marine 
hospitals maintained by the Federal Government, 
including all seaports. It consists either of small 
special hospitals, or of arrangements made with 
general hospitals in seaports to care for sick mari- 



In New Continents 145 

ners. The government also maintains hospitals in 
connection with immigration and Indians. 

II. Two Norwegian sailors from a barque called 
The Florida landed in 1815 at Caraquette, Glouces- 
ter County, N. B. Later two women, living at 
Tracadie and Neguaak respectively, who had washed 
their linen, became lepers. The disease then became 
endemic among the French settlements on the river 
Miramichi, the shores of the Baie des Chaleurs, and 
in parts of Cape Breton. In 1844, a hospital was 
built for these lepers on Sheldrake Island, near the 
mouth of the Miramichi River. In 1849, the insti- 
tution was transferred to Tracadie, N. B., and in 
1 868 placed in charge of the Sisters of St. Joseph from 
Montreal. The lazaretto was at first provincial, 
but after confederation became the property of the 
Federal Government. 

III. From 1800 to 1832 various epidemics affected 
localities, but none during that time seem to have 
invaded the whole country. Early in the nineteenth 
century cholera broke out in the Orient; by 1832 it 
had reached London, and, with every vessel, the pesti- 
lence was expected in Canada. The government 
took the precaution of opening a quarantine station 
at Grosse Isle, thirty miles below the port of Quebec. 
Temporary buildings were erected there, the station 
was under military control with military medical 
officers, two companies of regulars to do police work, 
and artillery with three mounted cannons to prevent 
ships from passing. On the 8th of June the cholera 
reached Grosse Isle, and went by leaps and bounds 
throughout Canada. Within three months, four 
thousand persons died in Quebec alone. Since then 

VOL. IV. — 10 



146 A History of Nursing 

there have been four outbreaks in Quebec Province 
(1834, l8 49> l8 5 2 > and 1854). At Grosse Isle, as 
matters passed from imperial to colonial government, 
military medical officers and men were replaced by- 
civilians, until finally the station came under the 
control of the Federal Government. Stations were 
also opened in 1832 at Halifax and St. John, N. B. 
Later on quarantine stations were opened at Sydney 
and Louisburg, C. B., Char lottet own, P. E. I., and 
Chatham, N. B., Vancouver and Victoria, B. C. 

IV. A series of Immigration Detention hospitals 
was begun in 1904. They are found in Halifax, N. S., 
Sydney, C. B., St. John, N. B., Quebec and Montreal, 
P. Q., and Victoria, B. C. Graduate nurses are em- 
ployed in them as occasion demands during the ship- 
ping season. The Detention Hospital in Quebec, 
which accommodates five hundred inmates (civically 
and physically unfit) is a particularly interesting 
post for a nurse. 

V. The energies of the State in relation to the 
Indians are chiefly displayed in reference to tuber- 
culosis. A tent hospital of fifteen beds was founded 
in 1908 on the Six Nations Reserve near Brantford, 
Ontario. There is another at Birtle Indian Agency, 
Man. At Morley, in Alberta, is a wooden hospital, 

as well as tents, and in British Columbia there are 
provincial hospitals in which are medical superin- 
tendents. 

VI. Hospitals for the Insane. Little is known of 
the condition of the insane during the French regime, 
and for seventy-five years after the establishment of 
British rule they were cared for in almshouses and 
jails. The present system is in process of evolution 



In New Continents 147 

to a more scientific foundation. The training of 
nurses for hospitals for the insane has begun, the 
first example being that established at Reckwood 
Asylum, at Kingston, Ontario, in 1888, under Dr. 
C. R. Clarke, then medical superintendent. The 
course, as everywhere at that time, was for two years, 
while the curriculum of study was arranged like that 
in the general hospitals. This departure worked won- 
ders in the hospital. Its graduates took post-graduate 
courses in general nursing, and succeeded admirably. 
Dr. Clarke later took charge of the Toronto Asylum 
and established a training school there also. 

In Nova Scotia a school was opened in 1894, in 
connection with the state hospital at Dartmouth, 
with a two years' course for men as well as women. 
Trained head nurses are placed in the wards. Many 
of these nurses have taken supplementary training 
and are filling important posts in Canada and the 
United States, chiefly in hospitals for the insane. 
The Prince Edward Island institution for the insane 
at Falcon wood opened a school for nurses in 1900. 
It is a thoroughly well managed and fully equipped 
hospital. 

Though New Brunswick was the first of the prov- 
inces to make provision for its insane, by converting 
an old cholera hospital in St. John into an asylum in 
1835, it has, as yet, no regular school for nurses in 
the Provincial Hospital at Fairfield, into which the 
original plant was merged in 1848. The Protestant 
hospital for the insane at Verdun gives its nurses 
practical training in the care of mental cases, and 
teaches them general nursing in the infirmary, but 
has not developed a regular training school. 



148 A History of Nursing 

Of recent times, the question of nursing the insane 
has been given consideration by Mr. Hanna, Provin- 
cial Secretary, with the result that Ontario established 
a Provincial Board, and all the hospitals for the insane 
in Ontario (which, as the wealthiest province, has the 
best provision for these unfortunates) , were required 
to develop schools for nurses. The board appointed 
an examining staff of medical men, and uniform ex- 
aminations were held for the first time in 19 10 in 
London, Toronto, and Kingston. A third year was 
next added to the training, which is thrown open to 
former graduates, if they desire to take it. Many 
have availed themselves of this opportunity. In 
Toronto and Kingston the lecturers are members of 
the university staff, and exceptional advantages are 
thus afforded the pupils. The board also discussed 
affiliation between schools in general hospitals re- 
ceiving government grants, and those in the service 
of the insane, as a desirable possibility. 

During 19 10, in Ontario, male wards for the insane 
were placed in charge of women nurses, with marked 
improvement in the management and well-being of 
patients. 

Quebec is the only province in which there are no 
state institutions for the insane. Its several asylums 
are owned by private corporations, though the prov- 
ince contributes to their support and has supervision 
of them. The largest ones are cared for by the Sisters, 
the Grey Nuns taking charge of 1200 patients in the 
Quebec Lunatic Asylum, which is their private pro- 
perty, and the Sisters of Providence in the asylum at 
Longue Pointe near Montreal, with its 2500 cases. 

An immense work is yet to be done in raising the 



In New Continents 149 

status and efficiency of the great numbers of nurses 
needed to care for these sufferers, and in perfecting 
their education and training. 

VII. Military Hospitals. — Information regarding 
early military hospitals is vague and fragmentary. 
There are documents extant, however, relative to 
such an institution at Kingston prior to 1790. The 
earliest hospitals for soldiers were, of course, the es- 
tablished institutions at the various towns and posts. 
At Annapolis and Louisburg there were hospitals 
established shortly after the garrisons, and they 
served not only the garrisons but any sick in those 
places. Between the years 1 759-1 814 temporary 
field shelter must have been erected wherever the 
wounded were not near enough to the established 
hospitals to be taken to them. At Quebec in 1759, 
the British took possession of the city hospitals and 
convents and erected field shelter outside the city, 
as well as on the Isle of Orleans. Shortly after the 
occupation of the British, garrisons were established 
throughout the country, and, in 1793, military hos- 
pitals existed in Sorel, Montreal, Kingston, York, 
Fort George at Fort Niagara, Amherstburg, and 
probably elsewhere. The present military hospitals 
of Canada are located at Halifax, Fredericton, 
Quebec, St. John's, Kingston, Petawawa, London, 
Winnipeg, and Esquimalt, B. C. 

In 1904, a very important addition was made to 
the militia of Canada, when a regulation added to 
the establishment of the militia a certain number 
of nursing Sisters. The Canadian nurses who had 
gone to South Africa had in every way upheld the 
honour and credit of the militia, and it was felt right 



150 A History of Nursing 

that they should be recognised as part of that or- 
ganisation. 1 The establishment authorised was 
twenty-five Sisters, who were given the relative rank 
of lieutenant in the army medical corps, with a pay 
of $2.25 a day when on duty, and the allowance of 
that rank. When the Dominion Government as- 
sumed charge of the large garrison at Halifax, with 
its military hospital of 120 beds, the want of nurs- 
ing was at once felt, and two nursing Sisters were 
added to the establishment of the Permanent Army 
Medical Corps. Miss Georgina Pope, Royal Red 
Cross (trained in Bellevue), and Miss B. Macdonald, 
both of whom had served with distinction in South 
Africa, were appointed to the positions. The Sisters 
of the Permanent Army have been augmented to the 
number of five or six and are stationed at other 
hospitals. The Sisters on the reserve list are required 
to take a course at Halifax under the nursing Matron. 
Army nursing in Canada is carried out by the whole 
of the personnel of the army medical service in the 
various military hospitals and during annual training 
at the several camps. The personnel is composed 
of officers, nursing Sisters, warrant officers, non- 
commissioned officers, and men of the permanent 
medical corps and the army medical corps. The 
men are trained by the officers and nursing Sisters. 
If at any time the services of the Canadian forces 
should be needed for the defence of the empire, nurs- 
ing Sisters would form an important part of these 
forces. Preference for employment would, of course, 



1 The Canadian Nurse, March, 1907, p. 129. Article by G. C. 
Jones, Chief Military Medical Officer to the Dominion. 



In New Continents 151 

be given to those already holding commissions in 
the army medical corps. 

Anti-Tuberculosis Work. — Slowly the people of 
Canada are awakening to the need for an active cam- 
paign against tuberculosis. To wage effective war- 
fare, concerted action of Provincial and Federal 
Government is needed, and the difficulties hitherto 
found in the way of such action must be overcome. 
The Federal Government's activities on this line now 
appear in its relations to its wards, the Indians, and 
to immigrants. With the former a beginning has 
been made by removing affected Indians from their 
homes to tent hospitals on the Reserves. A num- 
ber of such outdoor colonies have been provided, each 
one in charge of a nurse, who also acts as district 
sanitary inspector. Nurses are being employed in 
ever larger numbers to carry out the preventive and 
educational work of the various local, provincial, 
and national associations. In Toronto, there are 
municipal visiting nurses for the tuberculous poor. 
It is scarcely possible to indicate the extent to which 
nurses are active in such work, as it grows too rapidly 
for figures to be followed. Of the hospitals for tuber- 
culosis, most have at least a trained nurse as super- 
intendent, while others have an entire staff of 
graduates, and still others have training schools 
affiliated with general hospitals. In this class is 
the Lady Grey Hospital at Ottawa, which sends its 
pupils for part of their three years' course to Bellevue 
and Allied Hospitals in New York. 

The Victorian Order. — The Victorian Order of 
Nurses is the national district nursing association of 
Canada, founded in 1897 by Lady Aberdeen to do 



152 A History of Nursing 

for Canada what the Queen's Jubilee Nurses had done 
for Great Britain; but with this difference, that not 
only are the indigent poor cared for in their own 
homes, but also the people of moderate means. Up 
to 1897, two large classes had been practically un- 
cared for in time of illness — the indigent poor and 
the hard-working, self-respecting class who could pay 
something, but not the fee of a private nurse. In 
many districts, hospitals did not exist, and where 
they did, it was often impossible for the patient to 
leave home. The objects of the Order as set forth in 
the Royal Charter are stated as follows: (1) To sup- 
ply nurses thoroughly trained in hospital and district 
nursing and subject to one central authority, to care 
for the sick in their own homes, in town and country 
districts. (2) To bring local associations into affilia- 
tion with the Order and to afford pecuniary and 
other assistance to such local associations. (3) To 
maintain a high standard for all district nursing. (4) 
To assist in the building of small cottage hospitals 
and homes. 

The chief object was district nursing, and at first 
the activities of the Order were directed solely toward 
that end. During the first three years, local associa- 
tions for supplying district nurses were organised 
in the large cities and towns. In the year 1900, 
during a tour through the North and West, Lady 
Minto, then Honorary President of the Order, real- 
ising that the people in remote regions needed more 
adequate nursing care, started a fund known as 
"The Lady Minto Cottage Hospital Fund," from 
the interest of which grants are made from time to 
time by the V. 0. towards the building of small 



In New Continents 153 

hospitals in out-of-the-way places where they are 
most needed. So from 1900 on, the work of the Or- 
der has been twofold — district nursing and hospital 
building and nursing. In 1909, nursing in country 
districts was developed. In all parts of the Domin- 
ion, especially in the West and North, the cry had 
come to meet the needs of the women on the ranches, 
homesteads, and farms. This new development is 
known as "Lady Grey's Country District Nurs- 
ing Scheme." The plan is to organise local associa- 
tions in large country districts varying from one to 
ten miles in radius, within which the nurses work. 
Continuous and visiting nurses are combined. 

The problem of nursing the people in isolated 
districts can be solved only by an association of 
people bound together for that purpose. The indi- 
vidual nurse cannot solve the problem herself, nor 
is it her responsibility to do so. 

There is to-day no provision made for the training, 
licensing, and inspection of midwives in Canada. 
There are a number of midwives from England and 
foreign countries who practise, for the most part, 
among immigrants of their own nationality. Some 
have been trained in their own countries and many 
have picked up what knowledge they have as they 
went about. At present it does not seem advisable 
to do anything in Canada to encourage the establish- 
ment of a training for midwives; but probably the 
time will come when our foreign population shall have 
grown very large, when it will be imperative, as it 
is now in Great Britain and in the United States, 
to deal with this knotty question. In Canada, at 
the present time, old country midwives will not 



154 A History of Nursing 

solve the nursing problem of the West. Fully 
trained nurses, nothing less, will solve this problem, 
and the Order has a complete organisation for doing 
the work; funds only are lacking. 

The structure of the Order is simple. There is 
the central authority, the Board of Governors, con- 
sisting of five appointees of the Governor- General, 
who is a patron of the Order ; of representatives from 
each local association, and from each medical asso- 
ciation, both Provincial and Dominion. This man- 
aging board is very representative; each local as- 
sociation is closely tied with the central authority. 
The unity and strength of the Order are due to this 
centralised system. Nurses who join the Victorian Or- 
der must be graduates in good standing of recognised 
training schools connected with general hospitals. 
They must have a thorough training in obstetrics 
and must have taken, besides, a post-graduate course 
in district nursing. The work is spreading into other 
branches of philanthropic effort. In some parts, 
nurses are employed by the Associated Charities 
with satisfactory results. In some of our cities the 
V. O. nurses are working as tuberculosis nurses, 
often in connection with dispensaries or local bodies. 
In several cities the nurses employed in the public 
schools are members of the Order. 

The McDonald College of Domestic Science at 
St. Anne de Belle vue employs a V. O. nurse to give 
lectures to the pupils and teachers. 

There is a nurse on the reservation of the Six 
Nations Indians near Brantford who works under 
the New England Missionary Society of England, 
founded in 1661. She also looks after the social and 



In New Continents 155 

hygienic conditions on the reservation; for this pur- 
pose a horse and trap are provided. In many cities 
the V. O. nurses work in connection with the Milk 
Commission, taking charge of the depots and also 
instructing the mothers in the feeding and care of 
infants. At Harrington Harbour, Labrador, are 
V. 0. nurses in connection with Dr. Grenf ell's hos- 
pital. The V. O. has undertaken the nursing of the 
policy-holders of the Metropolitan Life Insurance 
Company, which has 200,000 industrial policy- 
holders in Canada. The total number of nurses 
working for the Order in 1 910 was one hundred and 
sixty, distributed as follows : In hospitals, thirty-two ; 
in districts, 1 sixty-four; taking post-graduate course, 
thirty-seven; nurses in training in hospital training 
schools, twenty-seven. There are four training 
centres: Montreal, Ottawa, Toronto, and Winnipeg. 

New districts are constantly opening up, and as 
the number of branches increases, more fields of 
usefulness will be taken possession of and tilled by 
the workers of the Order. 

There are several societies and missions employing 
district visiting nurses in cities, and in many places 
are parish nurses, all doing good work in their 
own way. Welfare work, or nursing among factory 
hands, as an instructive visiting nurse, has been 
introduced into Canada, and more than one large 

1 Districts: Sydney, Baddeck, Canso, Halifax, Yarmouth, St. 
John, Truro, Montreal, Lachine, Sherbrooke, Grand'Mere, Ottawa, 
Cobalt, Stratford, Gait, Gravenhurst, Fort William, Winnipeg, 
Lundreck, Fernie, Vancouver, and Victoria. Hospitals: Harrington 
Harbour, Almonte, North Bay, New Liskeard, Copper Cliff, Swan 
River, Minnedosa, Shoal Lake, Yorkton, Melfort, Indian Head, 
Kasco, Chase, Quesnel, Rock Bay, Revelstoke, Arrow Head. 



156 A History of Nursing 

factory in Ontario has its welfare nurse. Some 
of the large departmental stores employ a nurse to 
care for customers in emergency and to teach hygiene 
among the staff. 

Settlements. — The oldest settlement in Canada is 
in Montreal, in connection with the University Club. 
It has been in existence about twelve years and em- 
ploys at least one trained nurse. The second in age 
is the Evangelica Settlement, Toronto, opened in 
March, 1902. A trained nurse works in connection 
with this settlement, and effective work has been 
done in modifying and distributing milk to infants 
from a depot managed by the nurse, as well as in 
instructing mothers in the feeding of infants, care of 
bottles, etc. A third settlement was established in 
Ottawa, 1909. So far the work has been chiefly vol- 
untary, carried on by lay workers. It is hoped to 
acquire funds for a nurse in the near future. 

Milk Commission. — Chiefly through the efforts 
of the Women's Council in the larger cities, Mon- 
treal, Ottawa, Toronto, Hamilton, Winnipeg, and 
others, there are depots where milk is prepared ac- 
cording to formulas and distributed to infants. 
Usually a nurse is in charge of the depot and a visit- 
ing nurse is employed to instruct the parents. Fre- 
quently this instruction is given by V. O. nurses, or 
in connection with settlement or parish nurses' work. 

School Nursing. — According to the terms of con- 
federation (B. N. A. Act), education is in the hands 
of the Provincial Parliaments. Efforts have been 
made to secure recognition of the fact that sanitary 
and medical inspection of schools is a state duty. 
Up to the present time, however, school inspection 



In New Continents 157 

and the employment of school nurses are dependent 
upon individual or municipal school boards. 

In Montreal, through the efforts of a committee 
of the Montreal Women's Club, medical inspection 
of schools was inaugurated in 1906. In January, 
1908, two trained nurses, one of whom was on the 
Victorian Order staff, were engaged by the Board of 
Health. In March of the same year, the Protestant 
Board of School Commissioners also appointed two 
nurses of the V. O. at their own expense, and have 
since added another to their staff. 

Toronto was peculiarly fortunate in securing as 
superintendent of school nurses "the first public 
school nurse in America," Miss Lina L. Rogers, whose 
experience in school work in New York has been 
outlined in the chapter on the United States. After 
six years service there, she was called to Pueblo, 
Colorado, in 1909, to organise school nursing, and re- 
signed this position in response to urgent calls from 
the Board of Education to go to Toronto in February, 

19 10. Five assistants were appointed in May and two 
more in November of the same year. In February, 

191 1, thirteen additional nurses (making a total of 
seventeen) were appointed. The nurses inspect the 
children in the classrooms, referring all cases to the 
medical inspector for diagnosis. They treat minor 
contagious skin or eye conditions according to pre- 
scribed orders, visit the homes, instruct the parents, 
explain conditions, and advise. The appointment 
of Miss Rogers and the excellent organisation of the 
Toronto school work were largely due to the disinter- 
ested labours of Mr. J. Ross Robertson. 

The school nurses in Toronto recently considered 



158 A History of Nursing 

the question of uniting the public school nurses of 
Canada for mutual help and co-operation, and, to 
this end, organised the Canadian Public School 
Nursing Association. The Toronto public school 
board offers a one-month post-graduate course, under 
Miss Rogers's direction. Within one year thirteen 
nurses took this course with a view to filling similar 
positions in other cities. In 191 1, school nurses were 
employed in Montreal, Toronto, Hamilton, London, 
Brantford, Kingston, Stratford, Winnipeg, Regina, 
and Vancouver. 

Education and Organisation. — In considering 
standards of training and the professional education 
of nurses, we find lack of uniformity in all respects. 
There is no standard other than that imposed by 
custom, which varies in localities. Certain schools 
there are which rank among the foremost in the 
world ; they have held their own, some by virtue of 
the hospital with which they are connected, some 
through the influence of interested hospital boards, 
but usually through the persistent efforts of individ- 
ual superintendents of training schools. The large 
hospitals, as a rule, are graduating capable, well- 
equipped nurses. On the other hand, there are 
numerous small and special institutions issuing 
worthless diplomas in return for two or three years 
of hard work and inadequate training. This con- 
dition prevails, not only in the youthful West, with 
its sparse population, but, with much less excuse, in 
the East as well. 

The first Canadian schools, with few exceptions, 
were organised and supervised by women who had 
been trained in the pioneer institutions of the United 



In New Continents 159 

States, and who modelled their work along the same 
lines, laying down a course of training, at first of two 
years, with a curriculum corresponding exactly with 
that of the American schools. As changes in methods 
of work and training were introduced, often by 
Canadian-born women, into the United States, they 
were also introduced into Canada. Many superin- 
tendents of Canadian schools were members of the 
American Society of Superintendents of Training 
Schools for Nurses, organised in 1894, a society 
which has exerted a marked influence in Canadian 
as well as American hospitals. As early as 1896 
the matter of a uniform curriculum was brought for- 
ward by Miss Snively, then Lady Superintendent of 
the General Hospital in Toronto, and a paper upon 
the subject, read by her at the second convention of 
the society, with the subsequent discussion, had a 
definite effect in Canada. 

The large city hospitals have long lists of appli- 
cants from which to choose their probationers, but 
in proportion as hospitals are remote from attractive 
centres and environment, the difficulty in securing 
suitable candidates increases. Schools which are 
independent as to choice of candidates require a 
high school education or its equivalent. Those 
less fortunate are often obliged to accept such can- 
didates as may offer, irrespective of educational 
qualifications. 

Preliminary courses for probationers have been 
established at the Hospital for Sick Children, To- 
ronto, in 1906; at the Montreal General in the same 
year, and subsequently at the Victoria, in London, 
and at the Winnipeg General. The Royal Victoria, 



160 A History of Nursing 

Montreal, has adopted a class system which has many 
advantages. This plan, combined with a modified 
preliminary course, has been found feasible in many 
institutions. Two or three schools require a tech- 
nical course or domestic science training previous to 
entrance. While nearly all school authorities ac- 
knowledge the advantage of the preliminary course, 
the financing of such a course has proved the ob- 
stacle to its establishment generally. The proba- 
tionary term varies from two to six months. With 
few exceptions the length of training is three years, 
while hours of work average seventy weekly during 
the entire time. 

The custom of affiliating special or small institu- 
tions so as to give a general training is increasing. 
We find many instances of small schools affiliated 
with maternity and contagious hospitals and vis- 
iting nurse organisations, by this method giving 
the pupils the advantages of a thorough general 
training. For the establishment of this system we 
are largely indebted to the registration law of New 
York State, which, while it has no jurisdiction in 
Canada, admits the registration of such Canadian 
schools as meet its requirements and accepts their 
graduates as candidates for registration. 

Most schools still adhere to the old system of 
granting an allowance of a few dollars monthly 
throughout training. Some supply books and uni- 
forms with no allowance. Comparatively few have 
paid lecturers, most of them being dependent upon 
voluntary tuition or lectures by members of the staff. 
A few schools offer scholarships and many give 
prizes in competitive examinations. Uniforms con- 



In New Continents 161 

sist of the regulation print dresses, white aprons, and 
caps. Graduates usually wear white linen uniforms. 
In short, the rules and conditions prevailing in 
American hospitals obtain also in Canada, — nursing 
traditions, customs, variations of climate, and social 
conditions being almost identical, as well as the popu- 
lation, which consists of the original Anglo-Saxon 
and French, with an increasing proportion of peoples 
from European countries, Orientals, and an occa- 
sional African or North American Indian. 

Fields of activity for graduate nurses are ever in- 
creasing. We find graduates in permanent posts 
in the hospitals, acting as instructors and dietitians 
in institutions, doing office, district, visiting, and 
settlement work; school nursing, welfare work in 
factories or with the Milk Commission, inspecting, 
reporting, and instructing under boards of education 
and health and with Charity Organisation Societies 
here and there; also doing literary work, while one 
at least, in Canada, is the editor of a magazine. Priv- 
ate nursing still absorbs the majority, and for the 
tactful, thoroughly trained nurse, this demand al- 
ways exists. Work is obtained through registers, 
some of which are managed for private gain and 
others by nurses themselves co-operatively. Gradu- 
ates usually reside, when off duty, in Homes or in 
graduate nurses' clubs. The position accorded to 
nurses in society or in the homes of patients depends 
entirely upon themselves. 

Post-graduate courses are rarely taken advantage 
of in Canada. The Toronto General Hospital offers 
a post-graduate summer course. The Hospital for 
Sick Children in the same city has offered a course 



162 A History of Nursing 

in its baby ward. In Toronto, the school board gives 
a month's course in school nursing, and the Victor- 
ian Order gives courses in district nursing at each of 
its four training homes. If our nurses wished for 
special or post-graduate training, the hospitals of 
Canada would gladly arrange for it, to the mutual 
benefit of all concerned. 

At the time this is written we know of two hospitals 
only employing nurses as social service workers — the 
Children's, Toronto, and the Winnipeg General. 
Several have instructive visiting nurses in connection 
with their tuberculosis dispensaries. 

In almost every Canadian city are to be found 
private hospitals corresponding to the "Nursing 
Homes" in Great Britain. They are the private 
property of physicians, nurses, or stock companies. 
They are sometimes supervised by competent super- 
intendents and nursed by graduates, but too often 
by young women, who vainly imagine that they are 
receiving an equivalent in professional education for 
their time and energies. These inadequate small 
schools and correspondence schools, together with 
the unrestricted influx into the Canadian West of 
disqualified nurses and midwives from the United 
States and Great Britain, are an increasing menace, 
not only to the nursing sisterhood, but to Canadian 
society at large, a menace which can be checked only 
by the passage of a uniform registration bill in each 
province. 

Activity has been exhibited during the last decade 
in the formation of alumnae associations and local 
clubs and societies. In the different provinces, or- 
ganisations are forming with intent to obtain state 



In New Continents 163 

registration. Because of our political structure each 
province must have its own act. In the past, there 
has been lack of organised concerted action by the 
nurses of the various provinces, easily explained by 
distance and by the early stage of co-operative 
effort. 

Provincial associations, in 191 1, are found in Nova 
Scotia, Quebec, Ontario, Manitoba, and Saskatche- 
wan. That in Quebec is the oldest, having been 
founded in 1895 in Montreal, as the Canadian 
Nursing Association. It is affiliated with the Na- 
tional Council of Women of Canada. That in 
Ontario, named the Graduate Nursing Association 
of Ontario, founded in 1904, had in the subsequent 
nine years made three praiseworthy but fruitless 
attempts to carry a registration act through the 
legislature. 

Local associations of nurses are numerous, all fully 
self-governing, and every year they are becoming 
more influential and useful. 

The Canadian Society of Superintendents of Train- 
ing Schools for Nurses was established in March, 
1907. Miss Snively, whose efforts in its behalf had 
been largely responsib e for its creation, became its 
first president, and immediately threw all her energies 
and prestige into the work of bringing a national 
society for nurses into being. 

During all the later years of her work as super- 
intendent this had been her plan, signified long ago 
by her standing in the International Council of 
Nurses as a Councillor and Honorary Vice-President 
for Canada, for the purpose of the International is to 
unite national bodies for mutual aims and services. 



164 A History of Nursing 

Miss Snively's good offices were successful at the 
second meeting of the Canadian Superintendents 
in 1908, as a national society was then inaugurated 
and a provisional association formed, called The 
Canadian National Association of Trained Nurses. 
The well-merited honour of the president's place 
was offered to her, and under her leadership Canada 
entered the international group in London, 1909, at 
one of the most picturesque and stirring functions in 
which nurses have ever taken part. 1 

At the fifth annual meeting of the Canadian 
Society of Superintendents, the work lying to hand 
for the nurses of the Dominion was graphically 
summarised in Miss Snively's opening words: 

And now let me enumerate the objects of our associa- 
tion: "To consider all questions relating to nursing 
education ; to define and maintain in schools of nursing 
throughout the country minimum standards for admis- 
sion and graduation; to assist in furthering all matters 
pertaining to public health; to aid in all measures for 
public good by co-operation with other educational 
bodies, philanthropic and social ; to promote by meetings, 
papers, and discussions cordial relations and fellowship; 
and in all ways to develop and maintain the highest 
ideals in the nursing profession." Every clause there 
means work. The question of registration is one of 
supreme importance at this very time, and it is from this 
society, composed largely of the older and more experi- 
enced women in the profession, that help should be 
expected. . . . Then, too, the influence we may exert 
on all questions of public health and its allied depart- 
ments, all those matters which we roughly sum up as 

1 Second Quinquennial Meeting of the International Council of 
Nurses, Mrs. Bedford Fen wick, President. 



In New Continents 165 

social service problems, is very great. We are demand- 
ing more and more in our profession that our members 
be women of broad sympathies and culture, and, if such 
are to be encouraged, we must look to our superintend- 
ents of nurses to see to it that such qualities are fostered 
in their pupils. And, too, the social side of our society's 
work is of great importance. We are all bound together 
by one bond at least of sympathy and we must try to 
know one another and work together. . . . Following a 
suggestion, an effort has been made to arrange for talks 
to college women on nursing, with a view to attracting 
the college trained woman, especially for social service 
work. . . . This society is affiliated with the National 
Council of Women, and a report will be heard of its 
work. . . . 

In Canada, as in the United States, there is a 
society, founded in 1907, of hospital superintendents 
(who may be either physicians or laymen or nurses) , 
many of whose members are nurses, holding positions 
at the head of institutions. It had been proposed 
that the society of training school superintendents 
should form a subsection of this society, and meet 
with it. The report brought in by the committee 
in regard to this proposal was a frank and fearless 
one, and merits careful reading for its dignified self- 
assertion. It ran : 

This committee begs to recommend that this society 
do not amalgamate with the Canadian Hospital Asso- 
ciation — and for the following reasons: (i) There is 
enough work to be done in connection with training 
schools to keep one society busy, and the Canadian 
Society of Superintendents of Training Schools for 
Nurses can do that work better, more effectively, and 



166 A History of Nursing 

more sanely when it preserves its identity. There are 
many problems for this society to solve, for with its 
members really rests what the nursing profession is to be. 
(2) This society in its membership is strictly professional 
and educational. (3) It has been claimed that the union 
would make for economy — bargains are very doubtful 
blessings ; that all would reap the benefits of the papers, 
discussions, etc. But that may be obtained by arranging 
meetings as they are arranged during this convention; 
they are held at the same place and programmes are so 
worked out that members from both societies may 
attend all sessions, and union meetings and conferences 
may be arranged for as desired. (4) This society would 
gain nothing by the union, for the members of the Hos- 
pital Association know necessarily very little about the 
training of nurses, whereas the superintendents of train- 
ing schools know a great deal about the management of 
hospitals. The object of this association is to study out 
all the phases of training school work, so that its members 
may be mistresses of that branch — authorities — to whom 
all such matters should be referred. 

By all means, let us have sympathetic co-operation, 
friendly, helpful interest in each other's welfare, but — 
and this should be the watchword of our profession to-day 
— let us hold fast to this : We are specialists in training 
school matters ; we are mistresses in that part of the work, 
and nothing should make us give up that place. Let us 
hold fast to that, take nothing less. It is in this 
society, composed, as it is, of professional women of the 
highest type, that such truths will be fostered, that we 
shall, by careful study, build up our ideals, know what an 
influence we may be, and so be able to take our stand 
where it is intended we should. 

The report was presented by Miss Mary A. Mac- 
kenzie, Chief Lady Superintendent of the Victorian 



In New Continents 167 

Order of Nurses, and was adopted, thus securing 
the society an untrammelled existence. 

With a view to assisting the various provincial 
and alumnae associations, the Society of Superin- 
tendents of Training Schools appointed, in 19 10, a 
committee to consider standards of nursing education 
and registration and to confer with the provincial 
societies as to the drafting of a bill to meet the needs 
of nurses in all the provinces and, later on, lead to 
interprovincial registration. This committee con- 
sisted at first of Miss Mackenzie, Convener; Miss 
Louise Brent, and Mrs. Fournier, who were de- 
signed to be the nucleus of a large committee consist- 
ing of representatives from the national and from 
each provincial association. The work of this com- 
mittee was to prepare a model bill to be presented 
before each provincial legislature, the result hoped 
for being — Dominion Registration. 

The general scheme included affiliation with central 
technical schools, universities, or groups of hospitals, 
so as to make thorough preliminary and didactic 
instruction possible without increased financial effort 
on the part of individual hospitals. 

The Canadian Nurse is the official organ of all the 
organisations among nurses in Canada. It appeared 
first in 1905 as a quarterly, under the management 
of a publication committee composed of members 
of the alumnae association of the Toronto General 
Hospital. In another year all the alumnae societies 
in Toronto were on this committee, and in 1907 this 
local publication committee was replaced by a 
broadly representative editorial board, with a 
member from every province in the Dominion. 



168 A History of Nursing 

Miss Bella Crosby told the story of its growth, in 
Paris. 

It is to an impulse from the great Canadian West that 
we owe the founding of our national nurses' magazine. 

Miss Lennox, the president of the Alumnae Association 
of the Toronto General Hospital in 1904-05, had resided 
for some time in Alberta and had an opportunity to 
realise the need of such a magazine, not only in the cities 
but on the prairies. 

Also it is to be remembered that the Association of 
Graduate Nurses of Calgary, Alberta, wrote to the 
Toronto Medical Society about the founding of a nurses' 
journal almost at the same time. 

In the presidential address of Miss Lennox, delivered 
in November, 1904, she said: "The work I most desire to 
accomplish this year is the institution of an alumnae 
journal. ..." 

At the regular monthly meeting of the Alumnae Asso- 
ciation of the training school of the Toronto General 
Hospital for December 13, 1904, Miss Hodgson gave a 
paper on the advisability of publishing a periodical. 

A committee was then formed, composed entirely 
of alumnae members, to promote the enterprise. 
The greatest difficulty was to find an editor, and 
finally the nurses persuaded Dr. Helen MacMurchy, 
an old friend of Miss Snively, and well known for 
her public work of many kinds, to fill the position 
until a nurse as editor could be secured. 

Already the magazine was assuming a national charac- 
ter. ... It enlarged rapidly; Montreal, Winnipeg, and 
other cities lent aid, and before the end of a year, the 
Canadian Nurse was the official organ of eight societies 



In New Continents 169 

. . . The first year closed with a well-established journal, 
free of debt and with a small balance to its credit. Both 
editor and business manager were paid a modest sum 
for time and work generously given. . . . Great services 
were rendered by Miss Hargrave, who proved herself, 
from the beginning, an ideal editor of one of the most 
important departments of the magazine, and endeared 
herself to the committee and to the subscribers by her 
unfailing loyalty, interest, and enthusiasm. The same 
may be said of Miss Mitchell, the convener, Miss Hodg- 
son, the assistant editor, and also of Miss Christie, the 
business manager, whose work in that department was 
admirable. x 

In 19 10, Miss Bella Crosby, a graduate of the To- 
ronto General, was made editor, and an editorial 
board was formed to represent every province and 
every nurses' association in the Dominion. Yukon, 
Labrador, and Newfoundland have their representa- 
tives, and even the Canadian nurses in the United 
States have one, upon this board. The Canadian 
Nurse has a future of importance before it, in welding 
the nurses of the broad provinces into one united 
body. 

Between Canada and the United States there has 
always been a lively reciprocity in nursing affairs. 
Because avenues of self-support for cultured women 
are fewer in the former, more conservative, country, 
the career of nursing has attracted there a pro- 
portionately large number of exceptional women, 
many of whom, in the United States, have found 
abounding opportunities, and, in return, have con- 
tributed notably to professional progress. Across 

x The Canadian Nurse "Reports," Paris Conference, 1907. 



170 A History of Nursing 

the border, freedom to develop initiative is greater 
and more room for experiment is allowed. To a 
certain extent, British conservatism checks the Cana- 
dian spirit at home, and medical guardianship of 
nurses is, in some centres, fairly strong, while the 
fell influence of the London group of reactionaries 
is occasionally perceived in the hospital atmosphere. 
But nurses realise more clearly every day that they 
must work out their own salvation. To-day is the 
dawn of organisation and progress. 

If you will only multiply the smallest force by time 
enough, it will equal the greatest; so it is with the slow 
intellectual movement of the masses. It can scarcely 
be seen, but it is a constant movement. It is the shadow 
on the dial — never still, though never seen to move. It 
is the tide — it is the ocean, gaining on the proudest bul- 
warks that human art or strength can build. It may be 
defied for a moment, but in the end it always triumphs. 

Newfoundland, the independent little British col- 
ony, conservative, and cherishing its individuality 
has given the profession of nursing some of its best 
members. Its first hospital was a military one in 
St. Johns, first in use during the middle of last 
century. About 1870 that series of enlargements 
began which now make it a general hospital main- 
tained by the government, and having a capacity 
of something under 150 beds. Only ten years ago 
training was unknown in Newfoundland nursing. 
To celebrate Queen Victoria's Jubilee, the women of 
the island gave the general hospital two wards for 
women, and in 1903 a training school was organised 
there by Miss M. Southcott, who came from England 



In New Continents 171 

with the certificates of the London Hospital, the Lon- 
don Obstetrical Society, and the Plaistow midwifery 
course. This school, still small, has an excellent 
three years' course covering all branches of work. 
Near the General is a government hospital for con- 
tagious diseases, and a convalescent home founded 
by the " Ladies of the Cowan Mission" in memory 
of the hospital's first Matron, Miss Cowan. The 
government also controls the hospital for the insane. 
Anti- tuberculosis work, well under way, is partly 
under private and partly under governmental direc- 
tion. At the camp started by the Daughters of the 
Empire, a St. Johns General graduate, Miss Camp- 
bell, was the first nurse to take charge, and the same 
hospital supplied the trained women who initiated 
visiting work in the city and outposts, and who, in 
the summer, make the tour of the whole coast. Nurs- 
ing organisation, spoken of but, up to 191 1, not 
brought about, must soon come. 

Labrador. — Upon the coasts of Newfoundland and 
Labrador is carried on one of the famous missions 
of the world, known widely and well as Dr. Grenfell's 
work among the deep-sea fisherfolk of the Northern 
coasts. Wilfred Thomason Grenfell, whose spirit 
imbues the whole, was born in England in 1865 and 
engaged as a medical missionary in the work of the 
Royal National Mission to Deep-Sea Fishermen, in 
1889. He fitted out the first hospital ship for 
British fisheries in the North Sea, and in 1892 went 
to Labrador, where he devotes himself to the religious 
and industrial improvement and the medical and 
nursing care of the people. A man of keen practical 



172 A History of Nursing 

sagacity and much magnetism, he has enlisted nurses 
to help him, whose lives and duties are among the 
most picturesque in all the annals of district nursing. 
A Canadian graduate of the Illinois training school, 
Miss Edith Mayou, became his chief head nurse, 
and the alumnae of the Johns Hopkins school under- 
took a sort of sisterly responsibility to keep his staff 
filled, and have sent several of their Canadian mem- 
bers to posts in Labrador. The Mission has five hos- 
pitals, four on the Newfoundland and one on the 
Labrador coast, while other stations are opened up 
yearly, where the boats call to treat and transport 
patients. Original articles by nurses in the Ameri- 
can Journal of Nursing and that of the Johns Hop- 
kins Alumnae Association give graphic accounts of 
their life among the simple seafaring people and well 
merit a transcription, for which our pages are too 
short. 

Australia. — A hundred years ago, in October of 
1811, the first hospital erected on Australian soil was 
opened for the reception of patients. With the 
Sydney Infirmary (now Hospital) the history of 
nursing in Australia begins. Were it possible to 
obtain a faithful picture of hospital life in the early 
days, we should, no doubt, be surprised at the rapid 
strides made by the nursing profession in the last 
fifty or sixty years. For although some of the hos- 
pitals date back to the earlier decades of the last 
century, the nursing practised within their walls 
was very primitive. The early Matrons were house- 
keepers, who attended to the feeding of the inmates, 
and the care and cleansing of the house. It is re- 





< m 



In New Continents 173 

corded of most of them that their institutions were 
models of cleanliness, which is, considering the dis- 
advantages under which they worked, a record of 
no mean attainment. 

As early as 1868, however, a training school was 
established by Miss Lucy Osburn, Lady Superin- 
tendent of the Sydney Hospital. Miss Osburn was 
one of five Nightingale nurses who came from 
England in March of that year. The Australasian 
Nurses' Journal 1 says that she and her companions 
were specially selected by Miss Nightingale herself as 
suited for work in the colony, at the request of Sir 
Henry Parkes, who had corresponded with Miss 
Nightingale about his desire to alter the nursing 
system in the Sydney — then the only large hospital 
in the city. That the early Nightingale nurses were 
a remarkable group of women is emphasised afresh 
by every recollection of them. In 191 1 , two Austra- 
lian nurses were still living who had been trained 
under Miss Osburn, and one of them said of her: 
"She was an exceptional woman, well-read, having 
an absolute fascination of manner and an indomit- 
able will. She looked upon nursing as the highest 
employment a woman could take up. . . . To her 
it was a holy mission, and should be entered into in a 
spirit of devotion, ..." 

Within four years the five nursing missioners were 
scattered over Australia, doing pioneer work in new 
hospitals in other colonies. 

Five more Nightingale nurses were brought out 
by the Tasmanian government a little later, and set 
to work in Hobart and Launceston, where training 

1 A Pioneer of Trained Nurses, p. 364, November, 191 1. 



174 A History of Nursing 

schools were, in time, established. Few of these 
nurses kept long to their original centre, their services 
being requisitioned by the new hospitals springing 
up all over the continent. It was, therefore, the per- 
sonal work and influence of the Nightingale nurses 
that began organised nursing, and subsequently 
organised training schools in Australia. 

In October, 191 1, the Sydney Hospital celebrated 
its centenary with suitable ceremonials and events, 
of which the one of most significance to nurses was 
the endowment of a bed by nurses past and present, 
for sick members of their guild. 

In 1871, Miss Haldane Turriff, one of the first 
Sisters of the Sydney Hospital, and a Nightingale 
nurse, was asked to take the matronship of the then 
new Alfred Hospital in Melbourne. This was one 
of two built to commemorate the visit of the Duke 
of Edinburgh to Australia, the other, the Prince 
Alfred, being in Sydney. Both have become im- 
portant and valuable training schools for nurses. 
The former enlarged and improved its training in 
the eighties, under the administration of the medi- 
cal superintendent, Dr. Backhouse, the nurses' course 
being lengthened to two years in 1887. Under 
the matronship of Miss M. D. Farquharson, an 
English nurse who was at the head of the school 
from 1890 to 1895, it was lengthened to three years. 
Miss Farquharson stood on the Council of the In- 
ternational Council of Nurses from its inception, 
representing the Commonwealth of Australia. 

The Prince Alfred Hospital in Sydney, which is an 
especially well-equipped and up-to-date institution, 
owes much of its prestige to the long service of Miss 



In New Continents 175 

S. B. McGahey, as Lady Superintendent, there. 
During the time she was connected with it she made 
a tour of the world, coming on the way to the Con- 
gress of Nurses in Buffalo, U. S., and taking back 
all the best ideas then available as to hospital con- 
struction and fittings. 

The Melbourne Hospital, which underwent re- 
building sixty-odd years after its foundation, opened 
its doors in 1848, its sole resident staff being an 
apothecary and a Matron. For many years the 
Matrons of this institution were only housekeepers, 
and, when the increasing number of inmates called 
for more attention, the staff was purely domestic. 
As in all Australian hospitals of that day, nurses' 
duties consisted in feeding the patients and keep- 
ing them and the wards clean. Almost all, even the 
most elementary details of nursing, such as taking 
temperatures and giving medicines, were carried out 
by the medical staff. The founder of the training 
school in the Melbourne was Miss I. J. Rathie, an 
Edinburgh Royal Infirmary nurse, who came from 
Hobart to the Melbourne in 1890. She brought 
with her two certificated Sisters, who assisted her 
in organisation. Miss Rathie was followed after 
five years by Miss Farquharson, who was the first 
here, as she had been in the Alfred Hospital, to give 
the nurses theoretical as well as practical instruction. 
They appreciated it intensely, and Miss Farquhar- 
son 's ten years' service in these two hospitals did 
much to set the high standard of professional in- 
struction demanded by Australian nurses to-day. 

Miss Weedon from the Charing Cross in London 
was the first trained Matron of the Brisbane Hos- 



176 A History of Nursing 

pital. She established the training school in 1885, 
and the first certificates were given in 1 888 . Previous 
to 1885, nursing in Queensland was very primitive. 
There were few nurses, if any, who had had the 
advantage of regular training. 

In Adelaide, the General Hospital was, until the 
year 1886, under the management of a housekeeper. 
In that year, two ladies trained in the London 
were appointed as day and night superintendents, 
and a training school was opened there. About 1886- 
f 88, regular organised training of nurses was estab- 
lished in most of the metropolitan hospitals, and 
certificates given. At first there was considerable 
difficulty in obtaining sufficient numbers of suitable 
probationers, and in some places it was even found 
necessary to advertise for them. There was a strong 
feeling against the name of the trained nurse, and 
of course the necessary changes in hospital adminis- 
tration met with much criticism. There are stories 
still told of medical men who were openly opposed 
to such a dangerous practice as the training of nurses. 
There were many difficulties to be faced and much 
hostility to be put up with, but the courage and en- 
terprise of the promoters of the movement were not 
to be quenched by any amount of wet-blanketing. 

Each town of any size has several hospitals, includ- 
ing those for children, for infectious diseases, and for 
midwifery. There are also hospitals for eye and ear 
treatment and for the treatment of mental diseases. 

Hospital training has naturally changed in many 
ways since the training school movement began. 
Originally nurses' bedrooms and board were of the 
plainest and roughest description, and their hours 



In New Continents 177 

were very long. The duties required of them in- 
cluded a vast amount of housework, which exhausted 
their strength and devoured their time in a most need- 
less way. By degrees ward maids and housemaids 
were introduced, thus relieving the nurses of much 
purely domestic work; more men were employed 
as porters, and nurses were no longer subjected to 
the harmful strain of carrying heavy patients and 
moving furniture. The older hospitals have been 
either remodelled or rebuilt, and modern labour- 
saving contrivances, lifts, etc., have been used. All 
this, with the increased comforts in nurses' homes, 
has made the life of the pupil nurse much less trying. 
She has now more time to devote to mastering the 
intricacies of her profession. New duties and fresh 
responsibilities have been laid upon her, and she is 
a much more highly trained woman than her sister 
of the eighties and early nineties. 

The general management of nursing education 
and public affairs concerning nurses is in the hands 
of two governing bodies, one, the Australasian Trained 
Nurses' Association, having its headquarters in 
Sydney, while the state of Victoria has its Royal 
Victorian Trained Nurses' Association. There is, 
besides these, a branch of the Royal British Nurses' 
Association in South Australia, which is in close 
touch with general nursing affairs. The Councils 
of the Australasian and Victorian associations are 
composed of medical men and members of the nurs- 
ing profession. There are representatives of the 
Matrons of hospitals, of the nurses themselves, and 
special representatives of the special training schools 
and the subcentres. 

VOL. IV. — 12 



178 A History of Nursing 

Of the beginnings of the Australasian Trained 
Nurses' Association, Miss McGahey reported, at the 
Buffalo Congress, that, as early as 1892, a meeting of 
medical men and nurses had been held in Sydney 
to consider what steps could be taken to form an 
association in that city, but so great was the diversity 
of opinion as to what constituted a "trained nurse" 
that no agreement could be arrived at. We next 
find that, in 1894, the Matron of the Launceston 
Hospital in Tasmania, Miss Milne, came over to New 
South Wales to confer with the Sydney Matrons upon 
the possibility of starting a nurses' association. On 
her return to Tasmania she tried to bring about the 
plan discussed, but soon found the time was not 
opportune. Miss Milne's keen interest in the social 
and educational progress of nurses induced her to 
consent to act as honorary Vice-President of the 
International Council of Nurses representing Tas- 
mania, in which position she stood for international 
relationships and professional union. A few years 
more brought success, for the small band of leaders 
was not to be daunted, and in 1899 another meeting 
was held in Sydney, New South Wales, and that 
association was founded which, at first, was named 
after the colony in which it arose, but a few months 
later, because of its membership from all colonies, 
was given the comprehensive name of The Austral- 
asian Trained Nurses' Association. Among the 
objects agreed upon at its inception was this one: 
"To establish a system of registration for trained 
nurses." The late Dr. Norton Manning was chosen 
as its first president, and Miss McGahey and Dr. Mills 
were made honorary secretaries. They worked most 



In New Continents 179 

enthusiastically at the general arrangements, and 
Very soon evolved regulations so broad and so suit- 
able that to-day, twelve years later, there are very 
few alterations, and these same rules govern the 
training and registration of nurses throughout the 
length and breadth of the continent. 

The Royal Victorian Trained Nurses' Association 
was inaugurated in June, 1901, with Dr. J. W. 
Springthorpe as its first president. The association 
was fortunate enough to remain under his guidance 
until 191 1, when he retired, and Miss Ayres, Matron 
of the Alfred Hospital in Melbourne, was elected pre- 
sident. This was the first time in the history of either 
of the Australian associations that a nurse was 
elected as presiding officer, and the event was com- 
mented on in the nursing journals with general ap- 
probation. The British Journal of Nursing said of it : 

The selection of Miss Ayres may be looked upon as a 
very happy augury for the future status of nursing in 
Victoria. Of Miss Ayres's professional work it may be 
said that no one has done more to raise nursing to a high 
standard than this lady, who, as the senior Matron in 
Melbourne, is beloved and respected throughout the 
state. Miss Ayres was one of the original founders of the 
Royal Victorian Trained Nurses' Association, and has 
worked loyally and effectively for its success. 

The two associations entered into a reciprocal 
agreement in March, 1902, and local councils of the 
Australasian Association were gradually established 
in Queensland, South Australia, Western Australia, 
and Tasmania. Each council is practically a self- 
governing body, only certain points, mostly inter- 



180 A History of Nursing 

pre tat ion of rules, being referred to the Central 
Council. The various councils all work with the 
same rules, and alterations to existing rules are 
referred to all states before final decision. 

The purposes and methods of the two ruling Aus- 
tralian associations are exceedingly interesting and 
worthy of careful study, while the results they at- 
tained are unique, for in no other country has a 
voluntary association of nurses — or of physicians 
and nurses — succeeded in imposing an educational 
standard on hospitals to the extent and degree 
witnessed in Australia, without state registration 
and simply by the force of its membership regu- 
lations and oversight of the whole nursing field. 
Through the two associations, working reciprocally, 
the training schools throughout the continent have 
been brought into line, and by means of a central 
examination for membership, held every six months, 
a high uniform standard has been attained. The 
minimum length of training has been fixed at three 
years in hospitals with a daily average of over forty 
occupied beds; four years for those of over twenty 
beds, and five for those of over ten. Each hospital 
recognised by the associations as a training school 
agrees to abide by the schedule of training laid down 
by the associations, and sends in to them annual 
reports of the progress of each pupil or nurse in train- 
ing. In this way the Council keeps in touch with 
its future members from the day they send in their 
papers to the Educational Committee; for every 
candidate for hospital training has to produce evid- 
ence that she has attained to a certain standard of 
education, and, failing such evidence, has to pass an 




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In New Continents 181 

examination to prove that she is sufficiently equipped 
as far as English and arithmetic are concerned. 

In much the same manner the training, preliminary 
educational test, and final central examination of 
obstetric nurses seeking membership is controlled 
by the association. Throughout Australia the time 
of hospital training in this specialty is twelve months, 
except in the case of general-trained nurses, who may 
qualify for an obstetric certificate by six months' 
training in a recognised obstetrical training school. 

In 191 1, the Australasian associations added an- 
other branch of nursing under similar rules, namely, 
that of mental nursing. For this specialty, a three 
years' training in a recognised government hospital 
for mental cases of not less than one hundred beds 
is required. Should registered mental nurses wish 
afterwards to train in general nursing, their mental 
certificate enables them to start in the second year 
of a three years' training school, the theoretical and 
practical tuition being on the same lines in both 
classes of hospitals during the first year. The as- 
sociations provide for the registration of nurses hold- 
ing general hospital certificates, also for those who 
hold, in addition, certificates of special training. 
Instruction in invalid cookery is an essential part of 
the general training. Nearly five thousand members 
belonged on the rolls of the two associations in 
1910-11, these numbers showing what a power they 
have made themselves. 

Nevertheless, in spite of the unusual power and 
influence gained over hospitals in specific points of 
educational requirements by the associations of 
nurses, and despite the results gained by voluntary 



182 A History of Nursing 

registration, far surpassing those achieved under 
voluntary auspices in any other country, the nurses 
and medical men of Australia came gradually to the 
conclusion that they must have the interference of 
the state in order to cope successfully with those 
institutions whose own standard as to education, 
or convictions of self-interest, clashed with the public 
good, as such centres could not be reached by the 
means available to a private society. For some years 
the growing evidence in this field occupied the minds 
and meetings of nurses. In April, 1906, a conference 
between delegates of the two associations was held 
in Melbourne, where many matters of common in- 
terest were discussed. Again, in July, 1909, a second 
conference took place in Sydney, and was attended 
by delegates from all the states of the Commonwealth 
working under the Australasian Trained Nurses* 
Association. One important subject discussed was 
the necessity for state registration, which was un- 
animously recognised as pressing. 

To provide for this reform, a bill was prepared and 
introduced by Dr. Mackellar, to whose unselfish 
labours in its behalf the gratitude of the nursing pro- 
fession is due. Among the deputation which waited 
upon the Minister of Public Instruction in the New 
South Wales Government were Miss Kendal Davies, 
Miss Gould, Miss Newill, Mrs. Ashburton Thompson, 
and Miss Sanders, as well as a number of physicians. 
Of the outlook for success the Australasian Nurses' 
Journal said in May, 191 1: "There seems every 
probability of having state registration of nurses in 
New South Wales by the end of the present year, 
judging by the favourable reception accorded by a 



In New Continents 183 

minister of the Crown to the deputation of the 
Australasian Trained Nurses' Association." This 
bill was passed in the Upper House, but before it 
went farther Queensland came to the front. In 
191 1 its government amended the Health Act, and 
nurses were taken by surprise to find that some in- 
sufficient clauses were being added, providing for 
registration. The Queensland Council at once called 
a special meeting, and the wishes of this professional 
body were submitted to the ministers, with the result 
that all their amendments, except two, were accepted. 
On January 1, 191 2, the act went into effect. It is 
considered by the nurses fairly satisfactory, and they 
will keep a close watch upon its administration. Of 
this event Miss Garran, secretary of the A. T. N. A., 
said: 

Under Australian conditions there are certain great 
advantages in the work of registration being done by the 
government, but there are also very great advantages 
in the present system of an independent body, which, 
though it receives government support and approval, is 
yet free from political influence. With our uniform sys- 
tem of training, examination, and registration, we are not 
so urgently in need of state registration as in a country 
like England where every hospital is a law unto itself. 
Here there is one system of registration and one standard 
from end to end of the continent. State registration will 
to a great extent break up this uniformity, as each state 
will have its own law on the subject. The aim of the 
A. T. N. A. is to bring pressure to bear in any state where 
a bill is introduced, so that any proposed legislation may 
be brought into harmony with our methods and stand- 
ards, but there are bound to be many and great differ- 



184 A History of Nursing 

ences in the laws passed by the various parliaments and 
in the regulations and by-laws passed by the local govern- 
ment boards. . . . 

The tendency in Australia — a tendency which has 
increased during the years that women have had the 
suffrage — is for men and women in all political, social, 
and professional associations to labour side by side at 
the work in which they are mutually interested and not 
to separate into opposite camps. This is especially the 
case with nursing, where, whether in hospital or in private 
work, the one cannot do without the other; and, indeed, 
from all I can gather from Australian nurses who return 
from their travels abroad, it seems that doctor and nurse 
work together on much more equal terms here than is 
the case in most countries. Certainly the medical men 
in Australia have worked hand in hand with the nurses 
to raise their professional training and status. 

Two professional journals are published monthly 
in Australia, the Australasian Nurses' Journal be- 
ing the organ of the older society, while Una is the 
periodical of the Victorian nurses. They are keenly 
alive on educational matters, giving much space to 
reports and discussions relative to the enforcement 
of their standards upon hospital training schools, 
and publishing fully the status of the various institu- 
tions from this point of view. They follow the eco- 
nomic circumstances of nursing with close scrutiny 
and clear vision, never losing sight of the need for 
keeping a good standard here as well as in education. 

Private nursing is the branch which accounts for 
the largest number of nurses on the register. There 
is abundance of work during the greater part of the 
year the demand for nurses at times exceeding the 



In New Continents 185 

supply. Private nurses are usually attached to a 
nurses' home. These homes charge a small weekly 
fee, and act as agents for the nurses, providing them 
in turn with cases. When they are in residence in 
the home, moderate board is also charged. Nurses 
belonging to the various homes are under the direct 
protection and guidance of the lady superintendent. 

Private hospitals which are registered by the as- 
sociations are pledged to employ only certificated 
nurses on their staffs. It is, therefore, now impossible 
for patients who pay for skilled attendance to be 
left to the uncertain ministrations of the partially 
trained nurse. 

It has long been evident that a considerable portion 
of the community was unable to face the ordinary 
nursing or private hospital expense, and yet not 
prepared to ask for treatment at the public hospitals. 
In consequence of this fact, much attention has been 
given of late to the question of the nursing of the less 
well-to-do. At the time when this is being written, 
some scheme for providing an intermediate hospital 
is being discussed in connection with the Friendly 
and Provident Societies. 1 

The nurses themselves have, to some extent, 
grappled with the problem, and have instituted 
visiting or hourly nursing. Much good work is 
being done, many sick folk being thus enabled to 
receive skilled attention in their homes, who otherwise 
would go to swell the hospital lists. It has been 
found possible also to overtake a number of cases 

1 These intermediate hospitals would probably receive patients 
who could pay a small reasonable sum per week, as is so widely cus- 
tomary in American hospitals. — Ed. 



186 A History of Nursing 

where some attention was required, but where 
the members of the family were quite capable of 
attending to the patient, once the important details 
were seen to by the nurse. The visiting nurse is a 
boon to the tired nurse with a heavy case, to give 
assistance with especially difficult procedures, or to 
relieve the nurse, in times of stress, for exercise or 
sleep. She has been well worth her small fee, and 
has, in some cases, saved the patient the expense of 
a second nurse. District nursing does very similar 
work in poorer circles, and it would be impossible to 
over-estimate its worth. 

"Bush nursing" is in its infancy, but it shows 
signs of lusty health and rapid development. Bush 
nursing means, in Australia, what rural nursing means 
in other countries: It is intended that no settler 
however remote, no little home, in however distant 
and lonely a part of "the bush" it may be found, 
shall be isolated beyond the possibility of skilled 
nursing care in time of need. Bush nursing is a big 
scheme and calls for much forethought and careful 
administration. Enthusiastic women, old enough to 
be experienced, yet young enough to be adaptable, are 
needed to fill positions as bush nurses; above all is 
it of the first importance that nurses undertaking such 
work should have had the fullest, most thorough, most 
well-rounded training that their country is able to 
give them, both general and special, for such women 
must be, in the widest sense, missioners of health as 
well as nurses of the sick, and they should be the 
very flower of their profession. This principle has 
been recognised in the high standard of qualifications 
demanded for nurses entering this service in Australia^ 



In New Continents 187 

and it may be concluded from the history of current 
events that the power of the professional associations 
of the country was successfully exerted to secure a 
model pattern for the equipment of the bush nurse. 

The Countess of Dudley has placed the Common- 
wealth in her lasting obligation by the splendid 
work she performed, in spite of much difficulty, in 
organising bush nursing. Others have helped, some 
with generous gifts of money — among these Madame 
Melba — but it was Lady Dudley's keen interest and 
untiring, enthusiastic work that began bush nursing 
in Australia. It had been her hope to establish it on 
a federal scale, covering the whole country in one har- 
monious network, and in the planning with this aim 
in view, Miss Amy Hughes, General Superintendent of 
the Queen's Institute in the mother country, had been 
called to Australia to confer and counsel. The large 
federal system, however, was not destined to spring 
full-fledged, and bush nursing began under state 
auspices, the first nurse being installed at Beech 
Forest early in 191 1. From this beginning it will, 
without doubt, spread from state to state. Tasmania 
has been making efforts to provide bush nurses for 
the many islands grouped about her. These islands 
have been for months in the year unable to obtain 
either medical or nursing assistance. 

Medical inspection of school children is enforced 
throughout Australia. In Hobart a nurse has been 
appointed to assist in such work, which will doubtless 
become more highly perfected and demand nurses 
in large numbers, providing a new opening for capable 
women as well as ensuring the well-being of schook 
children. 



188 A History of Nursing 

Lady Talbot has also left Australia a memento of 
her work for the sick and afflicted in the Talbot Milk 
Institute which she inaugurated during her husband's 
term of office as State Governor of Victoria. By 
means of this charity pure milk and ice are supplied 
to delicate babies. Two nurses are employed in 
connection with this institute, and their oversight 
and educational work, aided by the sufficient supply 
of pure food, has meant health and strength to many 
a puny, delicate child of the stifling back streets. 
Numbers of little lives must have been saved by 
the Talbot Milk Institute. 

In some centres nurses are employed as sanitary 
inspectors; while at least one insurance company 
is using a nurse in investigating and caring for 
" sick-pay* ' cases. 

Nurses' clubs are being talked of everywhere. 
Though few have as yet come into existence, the need 
is felt, and very soon every centre will follow the 
example of Sydney and have its own club. This 
will do great good, for the social side of nursing life 
might with advantage be improved and developed. 

Australian cities are said to be too lavishly sup- 
plied with institutions for the relief of the sick poor. 
It is claimed by some that the work could be done 
more conveniently and at much less expense of time 
and money, were the many merged in the two or three. 
While there is much difference of opinion on this 
point, it would undoubtedly be of advantage to the 
student of nursing to be able to take her special 
courses in her original training school, instead of, as 
at present, waiting admission to another hospital. 
There are registered training schools in all the 



In New Continents 189 

larger towns of the states, while in the small country 
towns there are cottage hospitals which are often very 
well built and up-to-date as to their equipment. 

With regard to the untrained nurse, she is with us 
in large numbers, continually exemplifying the truth 
of the saying — "A little knowledge is a dangerous 
thing." In midwifery practice especially she may be 
described as a danger to the community. But the 
day is at hand when all midwifery nurses working in 
Australia will be required to pass a state examination 
and be registered by the state. 

Much has been done in every way, during the past 
twelve years, by the two leading associations, but 
no record can give the true value of the work done 
by many individual women in the early days. To 
the Matrons and Sisters of our hospitals in the various 
states is due the advance from that time when igno- 
rant and uneducated women, many of whom could 
not even read and write, staffed our hospitals, to the 
present satisfactory state of nursing progress. The 
true history of Australian nursing is the story of the 
life-work of many honourable women. 

New Zealand. New Zealand is one of the young- 
est of Great Britain's daughters; discovered in 1769 
by Captain Cook, she was not settled for many years 
later. The history of the care of her sick in early 
days is fragmentary, and few records are reliable 
until the times when, population becoming more con- 
centrated in some centres, the different provincial 
governments found it necessary to provide hospital 
accommodation for the people. There was no settled 
system of nursing, nor were there trained nurses. 



190 A History of Nursing 

The Auckland was the first hospital established, 
the city of Auckland being the seat of government 
for the North Island. A site was set aside in 1850, 
and the patients now partaking of the benefits of 
the hospital have to thank the officials concerned 
for their choice of a most beautiful spot. The large 
area of land chosen is on a rise commanding an ex- 
tensive and most lovely view of the harbour. Here 
a small building was erected in 1850 or 185 1, no part 
of which now remains. It was designed by the Rev. 
Mr. Thatcher, private secretary to Sir George Grey, 
and had about ten beds for each sex, with living rooms 
for the Master and Matron, but no room for a resi- 
dent physician. There were no female nurses other 
than the Matron. Dr. Mackellar was the first medical 
officer. The hospital was managed by the provincial 
government until the abolition of provinces in 1875. 
At that time a stone building was put up which forms 
the nucleus of the present large hospital. Up to 
1883 it was under government control, when it was 
placed under a committee in part nominated by the 
governor and in part elected by the subscribers. 
A government inspector was then appointed to super- 
vise all hospitals. This was Dr. Grabham. His 
first report describes the nursing in this institution 
in 1883: 

The female nursing (which is confined to the large 
ward for females and to the female fever ward) is per- 
formed by the Matron, an assistant nurse, and a night 
nurse. The Matron takes her meals in an adjoining 
room, but sleeps at home, as also does the night nurse. 
In this division of the hospital the patients appeared to 



In New Continents 191 

be well and kindly treated. Everything was, moreover, 
orderly and very clean. I cannot, however, approve of 
the arrangement whereby at present the same nurses 
attend upon the ordinary patients and those suffering 
from fever. The same thing is done when scarlet fever 
is present. The male fever ward has nine beds; eight 
of these are occupied by typhoid fever cases, and the 
other by an old patient, who does the whole of the 
nursing. At present he has some assistance from a con- 
valescent patient, and he certainly does everything in 
his power for the good of those under his charge. The 
ward he keeps beautifully clean also; but the arrange- 
ment is a very bad one, and may end in disaster. The 
nursing — if I may call it by that name — in the other 
male wards is of the most wretched description. In No. 
I there is an old man who is paid to take charge of it. 
No. 3 is under the care of another old man, brought from 
the Refuge for that purpose. . . . 



The committee then appointed a trained nurse as 
superintendent and made Dr. E. D. Mackellar 
resident house surgeon with quarters in the building. 
In the inspector's next report, written in 1884, ^ e 
dwells on the improvements made since his former 
visit, and his satisfaction with the manner in which 
the committee and medical officers of the Auckland 
and other hospitals had received and carried out his 
suggestions. He then said: "We have now many 
establishments which, in their arrangements, order, 
and comfort, will bear favourable comparison with 
any of the European hospitals with which I am ac- 
quainted, and a spirit of emulation has sprung up in 
the Colony which cannot fail to have a wholesome 
effect." He goes on to say that a very excellent 



192 A History of Nursing 

system of nursing is in full operation at the Welling- 
ton and Christchurch hospitals, where well-educated 
ladies may be seen serving their apprenticeship with 
other "probationers." There were, however, ap- 
parently no regular training schools yet initiated. 
Miss Crisp is specially mentioned as possessing 
"in an eminent degree the qualifications which 
are desirable for her present position, and is ably 
seconded by her assistants." 

Miss Annie Alice Crisp, the new Lady Superin- 
tendent, was a certificated nurse, trained at Netley, 
and had been in active service in Egypt. On her 
appointment Dr. Mackellar recommended a staff of 
women nurses for the men as well as women patients. 
At this time the number of beds was — male, seventy- 
three; female, twenty-seven; no children's beds. 
Miss Crisp had as staff twelve nurses, two house- 
maids, three porters, cook and assistant. Five years 
later the training school for nurses was established. 
Dr. Mackellar took the greatest interest in this work, 
and even now he is looked up to by Auckland Hospi- 
tal nurses as the father of their school. Long after 
retiring from the position of medical superintendent 
he was an active member of the honorary medical 
staff, and still carried on the lecturing and teaching 
of nurses which he inaugurated. 

The modern Auckland Hospital is a fine and up-to- 
date institution of 340 beds. Attached to it and in 
the same grounds is a well- designed infectious annex, 
comprising two observation wards for suspicious 
cases, a building for scarlet fever, with two wards, 
nurses' quarters, and offices, and a similar one for 
diphtheria. There are a fine laboratory and a mor- 



In New Continents 193 

tuary in one building, and the hospital proper is 
built in blocks erected at different dates. Every 
ward has wide balconies to which the patients are 
wheeled to enjoy the beautiful view of the harbour. 
The new wards are known as the "Costley Block" 
from the name of the wealthy citizen who gave the 
funds to build a theatre and surgical wards for 
children. A large addition to the nurses' home is 
also new. The nursing staff is under the control of 
a lady superintendent, who has under her an assist- 
ant in charge of the home, where eighty nurses are 
in training. The course is for three years, and 
a very complete set of lectures is given by members 
of the staff, resident medical officers, and superin- 
tendent. The ward Sisters give the practical 
teaching. 

Under the control of the same board are the Costley 
Home for old people, with a trained nurse in charge 
of the women, and a convalescent home, to which the 
hospital nurses are sent for short terms. 

There was at one time a ward for maternity 
patients at the Auckland Hospital, and a good 
many nurses learnt maternity nursing there, but this 
was discontinued some years ago. The nurses have 
a good opportunity of experience in different branches 
of nursing. The probationers are given their turn 
in the infectious diseases' wards as juniors and again 
as seniors. The special children's ward takes in 
quite small babies and affords good experience in the 
diseases of children. One hundred and forty nurses 
have been trained and registered in the Auckland 
Hospital since "The Nurses' Registration Act " was 
passed. The Matrons who succeeded Miss Crisp 

VOL. IV. — 13 



194 A History of Nursing 

(afterwards married to Dr. Mackellar) were Miss 
Squire, trained at the Edinburgh Infirmary, who was 
appointed in 1895, and resigned after three years; 
Mrs. Wooten, trained in the Alfred of Melbourne, 
who remained till 1910, when she was succeeded by 
Miss Peiper, trained in Invercargill Hospital and 
Matron for some years of the St. Helen's in Auck- 
land. Miss Peiper was one of the nurses who went 
to South Africa to nurse in the Boer War, and she 
obtained her midwifery certificate in London. 

The Wellington Hospital has the honour of being 
the first training school for probationers. In Dr. 
Grabham's report of his visit of inspection in July, 
1883, he mentions that "Dr. Hammond has been ap- 
pointed Medical Officer and Mrs. Moore, Lady Su- 
perintendent. The ' nurses' have been supplanted by 
probationers drawn from a higher order of society." 
He speaks of the need for better accommodation for 
the nursing staff: 

The lady superintendent should have apartments in 
such a position that, while within call, she would at 
times be free from the noises, bad smells, and other con- 
comitants of a residence close to the door of a large ward. 
The very successful introduction of the probationer sys- 
tem will also necessitate some structural additions of an 
inexpensive character. These nurses take the greatest 
possible interest in their calling, which they have chosen 
from other than pecuniary motives only; and I have no 
hesitation in stating that a foundation is here being laid 
for a considerable permanent benefit to the Colony. 

Later reports by Dr. MacGregor refer to the im- 
provement in the nursing staff of the hospital, and 



In New Continents 195 

especially mention Dr. Ewart (who was for about 
twenty years medical superintendent, retiring from 
the position only in 1908), and Miss Godfrey, who, 
trained under Mrs. Moore, became Matron in 1890, 
and retired in 1898, being succeeded by Miss 
Payne, who had been trained in the hospital under 
Miss Godfrey, and was afterwards for a short time 
Matron of the Christchurch Hospital. Miss Payne re- 
mained in office until 1903, when she left to take 
charge of the Rotorua Sanatorium, and was succeeded 
by Miss Pettit, but afterwards returned to her 
former post. In 1905, great improvements took place 
at this hospital, in the opening of a fine nurses' home, 
and special chronic wards. The Victoria wards, 
accommodating forty patients, are detached, and are 
a complete hospital in themselves. There are shel- 
ters for consumptives, and a new fever hospital with 
its own complete nurses' home under the same man- 
agement as the Wellington, though some distance 
away. 

Several of the Matrons of the most successful 
training schools, as Miss Thurston of the Christ- 
church Hospital, Miss McKenny of Wanganui, 
Miss Berry of Napier, Miss Todd of Timaru, Miss 
Gosling of Nelson, and Miss McGregor of Waihi, are 
Wellington nurses. 

The Christchurch Hospital was first built in 1862. 
There had been a small hospital previously at Lyttel- 
ton, but little is known of it. Dr. Dalgleish was the 
first medical officer, but there is no mention of a 
nursing staff. For about twenty years the old 
Christchurch was carried on under a house steward 
and housekeeper. There were then some women 



196 A History of Nursing 

nurses, not trained, but who were probably of a higher 
class than the servants, as it is mentioned that they 
took their meals in their own rooms and that the 
patients were kindly and carefully treated. A part 
of the building erected for twenty-five patients in 
1862 still stands, and in it are the dispensary and out- 
patients' department. The wards above were used 
as lumber rooms for many years, when, after a fire 
that destroyed two wards, they were again put into 
use for the patients thus turned out. The modern 
nurses thus learnt something of the disadvantages 
their predecessors had to labour under. In 1885, 
the first trained Matron was appointed. She was a 
Miss Paton, who had been for six months in a 
London hospital. Nothing more is known of her. 
The number of beds was then eighty. No attempt 
at training probationers was made until 1887. The 
chairman then offered a gold medal to the first nurse 
who trained there, but there is no record as to who 
received it. 

Two years later, we read that "the nursing system, 
one of the most essential features of hospital manage- 
ment, is well organised." Later the reports are not 
quite so satisfactory, as the house surgeon needs to 
insist that all vacancies shall be filled with well- 
educated young women, capable of profiting by such 
special training as every modern hospital of this 
size ought to impart to its nurses. In 189 1, the need 
of a home for the nurses is dwelt on, and it is pointed 
out that, until this is provided, the staff cannot be 
put on a proper footing of efficiency. It is recom- 
mended that one be built and the whole nursing 
staff reorganised. In 1894, came a period of trouble. 



In New Continents 197 

Miss Maude, a nurse trained in the Middlesex 
Hospital, had been appointed Matron, and had given 
splendid service in reorganising the nursing of the 
institution, but, unable to combat the prejudices 
engendered by the past system, resigned. She was 
followed by Miss Ewart, then a Sister in the wards, 
and trained in Belfast. After fourteen years' sway 
Miss Ewart was succeeded by Miss Thurston, trained 
at the Wellington Hospital, who, as the head of nurs- 
ing in all the institutions under the control of the 
board, supervises, besides the main hospital, the 
sanatorium for consumptives on the Cashmere Hills, 
the chronic wards for women at the Jubilee Memorial 
Home, a mile or two away; those for men at Ash- 
burton, and the hospital for fevers. Trained nurses 
belonging to the hospital staff are in charge of these 
outlying wards, and probationers are sent to them 
during training. A cottage hospital at Akaroa, a 
lovely seaside place, is also under the board and is 
staffed from the hospital. 

A new children's ward and one for gynecological 
patients enable Christchurch to boast of possessing 
the model wards of the Dominion. The children's 
ward is tiled throughout in pale blue and adorned 
with beautiful nursery pictures in tiles. The 
verandahs are wide, that cases may be treated in the 
open air. Convalescent children have a garden 
playground, and the women's ward a roof -garden. 

The Dunedin Hospital is the medical school of 
the Dominion, and its history has been of special 
interest on this account. Only sixty- two years ago 
was the Otago settlement founded and, two years 
afterwards, the first Dunedin Hospital erected. The 



198 A History of Nursing 

Memorials of John A . Torrance describe its earliest 

days: 

Like the gaol it was in advance of its time. . . . For 
over two years not one of its beds was occupied, and 
then also like the gaol, it was turned to a use never 
dreamed of. The insane persons had to be cared for, 
and so the first hospital became the first asylum, and for 
a time it served the double purpose . . . those physic- 
ally sick of course ultimately preponderating. But not 
until the discovery of the gold-fields in 1861, when im- 
migrants were poured into Dunedin by shiploads, was 
there any large demand for hospital accommodation. 

The hospital is now a large and handsome insti- 
tution, with well-equipped schools both for medical 
students and nurses. The training of nurses was first 
started in 1888, when lectures were given by the 
honor ary staff and an examination was held at the end 
of twelve months. At this time the Matron, Miss 
Burton, an estimable elderly dame still [in 191 1] liv- 
ing near the hospital and sometimes attending as an 
out-patient, was quite untrained. How her eyes 
must open at the appointments of the new out-patient 
department and the nurses on duty there ! When the 
question of giving lectures to the nurses arose, she 
said: "What do they want with lectures? I'll 
lecture them!" 

The time of training was first fixed at one year, 
and nurses were only placed in the women's wards. 
The first Matron with full training was Miss Edith 
Maw, who came from England in 1892, but was only 
in office for one year. In 1893, Miss Isabella Fraser 
trained in the Edinburgh Infirmary, came from Mel-, 



In New Continents 199 

bourne to succeed Miss Maw, and remained in her 
post for twenty years. She instituted a three years' 
course and placed nurses in all the wards. Large 
additions have been made to the hospital in all its 
departments, and it has also several dependent in- 
stitutions for infectious cases, chronic and consump- 
tive patients, all of which are under the one medical 
superintendent and lady superintendent, and are 
staffed from the main hospital. There are also 
several cottage hospitals or receiving wards in 
different parts of the district, with trained nurses 
from the general staff in charge. The Maternity 
of the Medical School is a well-equipped small 
special hospital where the Dunedin nurses receive 
midwifery training. This, however, is a dis- 
tinct post-graduate course of six months under the 
same rules as the state maternity hospitals. 

In addition to the four chief hospitals just de- 
scribed, there are over fifty others in New Zealand, 
with beds running from one hundred to ten. Some 
of these were established in districts which once pro- 
mised rapid growth and prosperity because of the 
existence of gold mines long since abandoned. They 
are now little more than homes for old people and 
refuges for disabled miners. 

The hospitals which train nurses are thirty, in 
all. Some of the medium sized ones, as Wanganui, 
Palmerston North, Waikato, Timaru, Napier, and 
Invercargill, are fine institutions, well equipped and 
staffed, and send out excellent nurses. With state 
registration, their training has come into line with 
the larger hospitals, and it is often a nurse from one 
of these schools who tops the list of examination 



200 A History of Nursing 

candidates. The history of the Masterton Hospital 
is interesting from the fact that its first Matron was 
a Nightingale nurse. The original building, put up 
in 1878, was paid for with funds collected by Miss 
Selina Sutherland, aided by a government grant. 
Miss Sutherland was a personality well-known for 
many years in Melbourne, Victoria, in connection 
with charitable work and the care of destitute 
children. In the early days before the existence of 
the hospital, because of her energetic efforts to get it 
for the district, and her care of the sick and afflicted, 
she was called the Florence Nightingale of the Waira- 
rapa. The first Matron, who had had some training 
under Miss Nightingale, was Miss Lyons, but she 
only stayed a few months, and then until 1897 the 
hospital was in the care of an untrained Master and 
Matron. In that year Miss Heath, a Wellington 
graduate, was appointed with two trained nurses as 
assistants. The new building was opened in 1907, 
and is a good specimen of a modern country hospital, 
as the old one is of the cottage hospitals of twenty 
years ago. 

The Nelson Hospital is fairly old. The present 
building was put up in 1867, but a still older one 
had been built before that by the provincial govern- 
ment. Its first trained nurse was Miss Dalton, an 
Englishwoman. A photograph shows her a com- 
fortable looking dame of eighteen stone, and it was 
once remarked of her that she did all the work that, 
in later times, fifteen nurses were needed for. Before 
retiring for the night she would put her head in at 
the ward door and call out : "Now ; any of you chaps 
want a drink? Because I 'm going to bed." Miss 



In New Continents 201 

M. Jones was appointed in 1893, and under her and 
Dr. Talbot a course of training for probationers was 
first started in 1897. 

These brief sketches of the principal hospitals 
and their gradual evolution as training schools show 
how primitive for some years were the arrangements 
for nursing the sick. The people in various districts 
built hospitals, recognising the need. In many 
country places it was indispensable to have some 
provision of the kind, as the men in this new country 
were mostly homeless, living in tents, and generally 
roughing it. The difficulty of taking proper care of 
them when in the hospitals was greatly accentuated 
by the scarcity of women, and owing greatly to that 
cause the systematic training of nurses was not pro- 
perly begun until about twenty-five years ago, and 
men were mostly nursed by men. In fact, in one 
hospital it was found that the only nurse at night was 
an old man, who attended on men and women alike! 

The appointment of an inspector of hospitals for 
the government undoubtedly aided greatly in bring- 
ing about a more correct method of administration. 
On his visits of inspection he could observe the needs 
of each institution, advise as to means of bettering 
each and every part of the organisation, and, being 
a medical man experienced in the management of 
hospitals in the old country, the nursing department 
was one in which he took great interest and was 
qualified to advise and suggest. The first inspector 
(Dr. Grabham) remained in office only about three 
and a half years, and was succeeded by Dr. Mac- 
Gregor, who carried on the work for twenty years. 
In 1895, a great step in the interests of nurses and for 



202 A History of Nursing 

the betterment of their training was taken in the 
appointment of Mrs. Grace Neill to the position of 
assistant inspector of hospitals and asylums, Dr. 
MacGregor having recognised that the numerous and 
delicate questions affecting women which had to be 
dealt with in connection with the system of charitable 
aid, and the administration of hospitals and asylums, 
ought to be handled in the first place by a woman. 
Dr. MacGregor considered that Mrs. Neill com- 
bined in a very high degree the ability, knowledge, 
and sympathy required for this position. She was a 
trained nurse, having undergone training in London, 
as Grace Campbell, at the King's Cross and Charing 
Cross hospitals. She held a St. John's House cer- 
tificate for midwifery, and, until her marriage, had 
been lady superintendent at the Children's Hospital 
in Pendlebury. She had, therefore, special qualifi- 
cations for the post to which she was appointed. 

After coming into office, and becoming thoroughly 
acquainted with the varying conditions under which 
the patients in the different hospitals were nursed, 
and the very unequal standards of the nurses sent 
out from them, both Dr. MacGregor and his assist- 
ant recognised the advisability of establishing some 
means by which the training of nurses could be 
regulated. 

At first it was proposed to establish a branch of the 
Royal British Nurses' Association, and negotiations 
were opened with that body, proposing affiliation, 
but these came to nothing, as the parent association 
would not agree to self-government for the colonial 
branch, and, though it was to be self-supporting, all 
subscriptions were to be sent home. Mrs. Neil] 



In New Continents 203 

was in England in 1899, and had an interview with 
some of the officers of the association, but reported 
that she saw no reason to expect the slightest ad- 
vantage to New Zealand, or help in establishing a 
standard of efficiency. In fact, it was found that 
no such guarantee of efficiency was even then estab- 
lished by that association, and the founders of it had 
already, disappointed, withdrawn from its ranks and 
were devoting themselves to strenuous efforts to 
obtain state registration. It was thus decided that 
only the power of laying down laws for the proper 
training and examination of nurses under state 
auspices would remedy the existing evils. Dr. Mac- 
Gregor made the statement: "Nothing short of this 
will ever secure efficient and trustworthy nurses for 
any country." 

Early in 1901, the government authorised Dr. 
MacGregor to prepare a bill for the state registration 
of nurses. No interference was contemplated with 
the right of every person to employ whatever nursing 
he desired — the state limiting itself to giving a reli- 
able list of nurses properly trained and tested by 
state examinations. The bill passed, but was some- 
what altered during its passage through the house. 
Members representing districts where the smaller 
hospitals were established would not agree to the 
minimum number of beds for training schools pro- 
posed at first, viz., 40, and though some limit and 
minimum should have been settled, this was not 
done, and any general hospital which complied with 
the terms of training and gave, to the best of its 
ability, the instruction laid down in the syllabus, 
was able to send its probationers up for examination. 



204 A History of Nursing 

While in older and more closely settled countries, 
no doubt, it would have been more easily possible to 
limit training schools to those possessing a certain 
number of beds, it is certain that, had it been done 
here, and with so high a minimum as 40, many ex- 
cellent nurses trained in some of the smaller hospitals 
would have been lost to the profession As a matter 
of fact, with very few exceptions, candidates for ex- 
amination do not come from the very small hospitals, 
or do not take it until they have had supplementary 
training in the larger ones. When the act first came 
into operation, nurses who had been previously 
trained, or who had had four years' experience, were 
registered, but after 1902, all New Zealand nurses 
had to pass the state examination. Some of the 
larger hospitals in which a systematic training had 
been carried out before this still held their own final 
examination, and gave a certificate independently 
of that given by the government. This is the correct 
thing, as nurses should value the certificate of their 
alma mater ; but the smaller ones seemed content to 
avoid the trouble of examinations and leave the work 
to the government. The regulations as to examina- 
tions, and the curriculum of training and syllabus of 
lectures, were drawn up by Mrs. Neill, and continued 
in use for several years without alteration. They 
were, however, in 1907, revised and altered, though 
it was not found necessary to make any very great 
difference in the main points. It is hoped later to 
amend the act in several details, especially with 
regard to the recognition of hospitals as training 
schools. 

We have gone thus fully into the institution of 



In New Continents 205 

state registration for nurses in New Zealand, as this 
Colony was the first of the British possessions to 
pass a bill for that purpose. 1 After two or three 
years of operation, the inspector-general of hospitals 
remarks in his annual report: "It is becoming daily 
more apparent that by the silent pressure of this 
law the nursing profession of New Zealand will be 
effectively organised." In the last report (written 
shortly before his death) of this able administrator 
of the New Zealand Hospital and Charitable Aid 
Department, he says : 

New Zealand has proved by five years' experience the 
advantage to medical men and the public, as well as to 
the nursing profession, of having a recognised standard 
of proficiency and consequent state registration. There 
is no fault to be found with our system of state registra- 
tion of nurses; it works well and maintains a standard 
which acts as a stimulus to hospital authorities. 

The nurses' registration act of New Zealand 
uses no compulsion, except that of enlightened self- 
interest on the part of the nurses themselves ; but it 
is rare indeed for a nurse to spend the necessary 
three years in a hospital, going through the routine 
of training, and not present herself for the state 
examination. No important hospital position can 
be obtained by a nurse unless she is registered. The 
number of nurses coming up for examination has 
doubled in the four years of 1906-19 10. The pro- 
vision for nurses coming from elsewhere to register 

1 Cape Colony had the first registration, but under a medical 
act. — Ed. 



206 A History of Nursing 

is perhaps rather lenient. Their certificate of train- 
ing from a recognised training school for three years, 
with a course of lectures and examination equivalent 
to that of New Zealand, is accepted, and they are 
not obliged to pass the examination. As a matter 
of fact, the need of nurses in New Zealand, in spite 
of (considering the size of the country) a fair 
number being trained each year, is so great that it 
was inadvisable to shut out desirable additions to the 
number from abroad. It may in the future be pos- 
sible to open the door less widely. 

The next step of importance to the nursing pro- 
fession in New Zealand was the passing of an act 
for the registration of midwives. This was accom- 
plished also by Dr. MacGregor and Mrs. Neill, and 
took place in 1904. The act provided for the 
registration of women with a certain amount of 
experience (gained during a minimum of three 3'ears) 
of the work of midwifery, and vouched for by medical 
men as understanding their work and being of good 
character. After 1906 women not so registered were 
no longer allowed to undertake confinement cases 
without a doctor, except in cases of emergency. In 
administering this act it was found necessary in far 
back country places to allow the word emergency 
a wide meaning, as many even of the experienced 
women did not avail themselves of this opportunity 
given them to register, and the work had to be carried 
on, while frequently the nearest doctor would be 
many miles away. Having passed a midwives' act, 
it was then necessary to provide means of training 
nurses as midwives. It had been necessary for 
women wishing to become properly qualified to go 



In New Continents 207 

to Australia or Great Britain for the necessary in- 
struction. In connection with one or two hospitals 
— the Auckland and the Dunedin, for instance — there 
had been maternity wards, but these were not 
organised training schools. The then Premier (Mr. 
Seddon), in order to meet this difficulty, determined 
to establish state maternity hospitals, and deputed 
the task of finding suitable buildings and organising 
hospitals in the four chief cities to Mrs. Neill. 
They were to be for the reception of the wives of 
working men, and a small fee was to be charged. 
Pupil nurses were to be taken and fully trained nurses 
with midwifery certificates were appointed Matrons, 
with one qualified assistant. The first four Matrons 
were Miss Wyatt, Miss Holford, Miss Peiper, and 
Miss Inglis. The hospitals were all named for St. 
Helen and a non-resident medical officer was ap- 
pointed for each one. Dr. Perkins, of Wellington, 
was the first appointee, followed by Dr. Agnes 
Bennett. Dr. Emily Siedeberg was appointed to 
the Dunedin, Dr. Alice Moorhouse to the Christ- 
church, and Dr. Tracy Inglis to the Auckland 
St. Helen's. 

The primary idea was that while the houses were 
to be comfortable for the patients, they should not 
be equipped in such a way that the nurses on going 
into ordinary homes would be at a loss to manage 
without what they had been accustomed to. There- 
fore, ordinary houses were selected and fitted up in 
a simple and inexpensive fashion. In such houses 
the work of the St. Helen's hospitals has been carried 
on for over five years. But it has grown so much, 
the people for whom the hospitals were intended 



208 A History of Nursing 

having appreciated the benefits of being nursed and 
cared for so thoroughly, that the time has come when 
more truly hospital-like places must be built and 
equipped, and the first to be built on proper hospital 
lines is to be erected in Wellington. During the 
time these houses have been established, the number 
of patients has more than doubled, and the pupil 
nurses also have doubled, and in some centres trebled. 

A regular curriculum of instruction and examina- 
tion is laid down. The term of training is twelve 
months for untrained women, but for registered 
nurses it is six months. Each pupil must personally 
deliver twenty women and nurse the same number 
through the puerperium. Contrary to the usual 
practice in home maternity hospitals, the nurses are 
trained to be maternity nurses and midwives. In 
the town, as a rule, they prefer to work under the 
doctors, but in the country they — being qualified to 
do so — must undertake the full delivery of cases, 
calling for a doctor only under certain rules laid 
down for their guidance. There are two hospital 
training schools for midwifery nurses (besides the 
four state St. Helen's hospitals), one established in 
connection with the medical school in Dunedin, 
and one built in Gisborne by a society of ladies. 
More and more the trained nurses of the Dominion 
are realising the value of midwifery training, and 
entering for their six months' course, after completing 
their general training. There are usually two or 
three registered nurses in each term at each of the 
hospitals. 

Before the third of the St. Helen's hospitals— that 
in Auckland — was established, their founder, Mr. 




'o 

o 

O 



In New Continents 209 

Seddon, died when on his way to declare it open. 
Of all the great work which this man, so gifted with 
the genius of statesmanship, accomplished for his 
adopted country, perhaps none will have such lasting 
effect and do so much for the coming race of New 
Zealanders as this of founding the four state mater- 
nity hospitals. They are a more enduring monument 
to his memory than any statue or tombstone can be. 
Mrs. Grace Neill, his helper in the work, resigned 
her position shortly after this time, and handed on 
the work of organising the fourth St. Helen's Hos- 
pital to her successor. Miss Hester Maclean was 
appointed to fill her place and commenced her duties 
as Assistant Inspector of Hospitals, Deputy Reg- 
istrar of Nurses and Midwives, and Officer in Charge 
of the St. Helen's hospitals, on November 1, 1906. 

Miss Maclean was trained in the Royal Prince 
Alfred Hospital, Sydney, and held the certificate of 
the London Obstetric Society, and the C. M. B. 
She had had experience as Matron of cottage hospi- 
tals and of the Women's Hospital, Melbourne, with 
various other posts, which fitted her for the position. 

Still another change was to take place in the gov- 
ernment department which held control over the af- 
fairs of nurses. Dr. MacGregor, who, with Mrs. Neill, 
the nurses of New Zealand have to thank for their 
state registration, died suddenly in November, 1906. 
Dr. Valintine was appointed to succeed him , and 
has carried on his work with the same regard for the 
general improvement of all hospital matters. As 
Registrar of Nurses he has the interests of the nursing 
profession very much at heart. In 1909 a new act 
for the management of hospitals and charitable aid 

VOL. IV. — 14 



210 A History of Nursing 

was passed by Parliament. This act, by placing all 
the institutions for the relief of the sick under one 
general control in each district, has rendered possible 
the training of nurses in a wider and more varied 
way than was possible before. This has been referred 
to in the accounts of the larger hospitals. Another 
very important change under this act, and one which 
opens out a wide field to trained nurses, is that the 
hospital boards are empowered to expend money on 
the nursing of the sick outside the walls of their in- 
stitutions. Thus they may pay nurses to take charge 
of distant parts of their districts, in this way bringing 
the benefits of the hospital system to those who are 
too far distant to avail themselves in illness of the 
benefits of the hospital itself, and yet under the law 
must contribute their share in rates. 

Back-block district nursing is the scheme for the 
relief of the sick nearest the heart of the inspector- 
general of hospitals. He, having been for years a 
country practitioner, working far out to the back 
blocks, knew what it was to have no help from a 
competent nurse, to have to ride away, after being 
called a distance of fifty miles to a case, knowing 
that his visit had been of little use owing to there 
being no one able to carry out his instructions. In a 
few years it is hoped there will be no country district 
without its nurse. Nurses of the highest ideals, 
unselfish, sympathetic, endowed with judgment and 
decision, well trained and experienced in both general 
and midwifery nursing, are needed for this work. 
Great responsibility will rest in their hands. Far 
away from a doctor, they will often have to act 
promptly without advice; they will have to diagnose 



In New Continents 211 

disease, will have to decide whether a doctor must 
come, whether a patient must be sent to hospital; 
on their good judgment and observation many a 
life will hang. Owing to an excellent telephone 
service, there are few places quite cut off from a 
doctor, but frequently it is impossible for him to get 
to a place in time. 

A recent case may serve as an example: One of 
our district nurses was summoned in the night by 
a lighthouse-keeper in the Sounds. His wife was in 
labour. At once a nurse set off, and after a wild, 
rough ride and scramble she arrived three hours 
later, to find her patient almost pulseless from hemor- 
rhage, the baby cold and almost lifeless. She set to 
work, and her efforts were rewarded — both mother 
and babe saved. Here it was an impossibility to get 
the doctor — he was thirty-five miles away. Immedi- 
ately after the arrival of the nurse, the tide came up 
and the lighthouse was completely isolated. Here 
is grand work for our nurses to do. The pioneers 
in this service are Nurse Bilton (the first to start), 
Nurse Warnock, and Nurse O'Callaghan. 

In some of the towns there is a system of district 
nursing organised by charitable bodies. Nurse 
Maude, formerly Matron of the Christchurch 
Hospital, started this work in Christchurch. In 
Wellington it is worked under the St. John's Am- 
bulance Association. Mrs. Rhodes, a philanthropic 
woman of ample means, largely finances this part of 
the work and was made by His Majesty King George 
a Lady of Grace of St. John. In Dunedin also a 
nurse connected with the St. John's Ambulance 
Society works among the poor. In Wanganui and 



212 A History of Nursing 

Palmerston North there are district nurses. There 
has not, however, been any very large extension of 
this branch of nursing. There is not the poverty 
among the people, the cities are not so crowded as 
in the Old Country, and they are well supplied with 
hospitals; therefore, the need has not been so 
apparent. 

We must not omit to mention a branch of nursing 
which has been established during the last few years 
in several of the cities by the Society for the Promo- 
tion of the Health of Women and Children, started 
under the auspices of Lady Plunket, wife of the late 
governor, at the instigation of Dr. Truby King, 
medical superintendent of one of the large mental 
hospitals. Dr. King had observed great neglect of 
proper infant feeding, and therefore, great loss of 
infant life, and determined that something must be 
done to educate the women of New Zealand in this 
direction. A babies' hospital was established in 
Dunedin, called the Karitane Home for Infants, and 
babies suffering especially from malnutrition were 
received there. A carefully worked out form of per- 
centage feeding and preparation of humanised milk 
was instituted under the direction of Dr. King, and 
nurses were taken for a special course of post-graduate 
training for three months. Branches of the society 
were formed in different cities and nurses sent for 
instruction, and then to take up "Plunket" nursing; 
namely, the visiting and advising of mothers on the 
proper care of their infants, teaching the preparation 
of humanised milk when the babies were not breast- 
fed, and general home hygiene. There are ten to 
twelve nurses engaged in this work. A subsidy is 




K K 




In New Continents 213 

given by the government to the Karitane Home and 
£50 per annum to the maintenance of each nurse up 
to the number of twelve. 

The history of nursing in New Zealand would not 
be complete without the mention of the efforts made 
to train some of the Maori girls to care for the sick 
of their own people. This training has been under- 
taken by the government, with the aid of certain 
hospitals. Schools for Maori girls have been estab- 
lished and aided by the government, where their 
general education is carried on, and as soon as this 
is completed some few are kept for an extra year and 
sent as day pupils to the main hospital in the town. 
This means that they still live at their school, but 
are given an insight ino nursing work. If they ap- 
pear to promise well they are then found vacancies 
as regular probationers in some hospital and go 
through the ordinary training of a nurse, passing the 
same examinations and receiving the same certificate 
as the European nurses. So far not many have yet 
completed this training, as it takes four years in all, 
and if they go in for an obstetric course also, longer. 

The two first nurses to obtain both their general 
and midwifery certificates were Akenehi Hei and 
Heni Whangapirita, about 1908. These nurses were 
then given appointments in the Native Health De- 
partment, and allotted districts in which to work. 
They were sent to cope with outbreaks of illness 
among the natives, and did splendid work. In an 
outbreak of typhoid in a pa on the Wanganui River, 
Nurse Akenehi made the natives bring their sick to 
the meeting house, in which she established an ex- 
tempore hospital, and also made them dig drains and 



214 A History of Nursing 

improve the sanitation of the pa. Nurse Heni was 
sent to assist her, and together they brought fourteen 
patients to recovery and prevented further spread of 
the disease. It is sad to record that later, after 
nursing some members of her own family suffering 
from this illness, Nurse Hei contracted it herself, 
and succumbed after a short illness. Her loss is an 
almost irreparable one to the Maoris, as she was a 
woman of fine character and with the highest ideals 
of nursing and improving her people. The second 
Maori, Nurse Heni Whangapirita, is unlikely to 
continue her work. She recently had a severe at- 
tack of typhoid and pneumonia, and has not fully 
recovered. Those Maori girls who are now in train- 
ing have a great example before them in Nurse 
Akenehi Hei, whose work was appreciated alike by 
Maori and European. 

The nursing of infectious diseases has not been 
made a specialty, all the infectious disease hospitals 
being connected with the general hospitals and 
treated as separate wards to which nurses are sent 
for a term during their three years' course. The very 
occasional cases of smallpox or plague are nursed 
in the quarantine stations by private nurses and are 
too few in number to afford any opportunity for 
training probationers. 

Outside of hospitals and public institutions the 
nurses of New Zealand are largely employed in 
private nursing, and in carrying on private hospitals. 
Private nursing is mostly carried on from the prin- 
cipal cities, from which the nurses travel to country 
cases. In some of the country towns there are a 
few private nurses, but this is the exception. 



In New Continents 215 

Until a few years ago there was no organisation 
among nurses. The first attempt at anything of 
the kind was started in Wellington by a small resi- 
dential home being established and managed by Mrs. 
Holgate, who at the same time conducted a private 
hospital for women. An association of private 
nurses was formed, and Mrs. Kendall, formerly a 
nurse at St. Bartholomew's, and the possessor of the 
Royal Red Cross for services under fire in India, 
was elected president. Later, this private nurses' as- 
sociation enlarged its aims, and became the Associa- 
tion of Trained Nurses. At the same time a bureau 
was maintained and a large residential club estab- 
lished under the control of a council elected by the 
members, and a Matron, appointed by the council, 
carried on the home. In Dunedin an association 
of hospital and private nurses was started and a 
bureau also conducted. The example of the nurses 
in these two cities was followed by those resident 
in Auckland and Christchurch. Later still, the 
four associations agreed to affiliate and become the 
New Zealand Trained Nurses' Association, with 
four branches — Wellington, Otago, Canterbury, and 
Auckland ; all adopting similar rules and working for 
the same objects. A central council for the whole 
association was elected in 1909, composed of four 
members from each centre, and Miss Maclean, the 
Assistant Inspector of Hospitals and Deputy Regis- 
trar of Nurses was elected President, with Miss 
Bicknell, of the Hospitals' Department, Hon. Sec- 
retary. The formation of these associations has 
resulted in more unity among the nurses, and much 
benefit has been derived from lectures delivered by 



216 A History of Nursing 

doctors on various subjects, and by the opportunities 
given of meeting and discussing many subjects of 
interest. 

In January, 1908, the first publication of a nurses' 
journal for New Zealand was issued. Kai Tiaki, 
edited by Miss Maclean, is a quarterly, and the 
official organ of the four branches of the Trained 
Nurses' Association. It aims at keeping the nurses 
of the Dominion in touch with each other by personal 
news of hospital changes, and with the rest of the 
nursing world by giving news of the great develop- 
ments of nursing in other countries. It also aims at 
improving knowledge of modern medical and surgical 
treatment, by publishing lectures and articles by 
medical contributors and by encouraging the reports 
from nurses themselves of their experiences and 
observations. 

Private hospitals are legislated for in a part of 
"The Hospitals and Charitable Institutions Act, 
1909." This is not the first legislation in regard to 
them, as they were first dealt with in an amendment 
to "The Public Health Act" and again in a separate 
act in 1906. But the whole spirit of the legislation 
is the same — the protection of the public by inspec- 
tion and control of these places by the government. 
Every house in which more than one person is re- 
ceived at a time for medical and surgical treatment 
and in which obstetric treatment is intended, must 
have a license to conduct a private hospital. A 
heavy penalty is imposed for receiving patients 
without a license. Except under special circum- 
stances, a license is not granted to any one but a 
registered medical practitioner, a registered nurse 



In New Continents 217 

or midwife. Testimonials as to good character are 
also required. The premises to be used are inspected 
and the number of patients one registered nurse can 
be responsible for are specified. The licensed private 
hospitals are visited periodically by trained nurses 
appointed by the government for the purpose. The 
licenses have to be renewed annually, and can be 
cancelled for certain reasons. A record of the 
patients treated and the work done has to be kept, 
and submitted to the inspectors. The nurses ap- 
pointed for this work first were Miss Bicknell and 
Miss Bagley, both New Zealand trained nurses and 
midwives. They visit the private hospitals and at 
the same time see the registered midwives in the vari- 
ous districts, and work specially under the superin- 
tendence of the Assistant Inspector-General, Miss 
Maclean. 

Under an Act for the Protection of Infant Life, 
which was passed in 1908, there is an opening for 
the trained nurse which so far has not been taken 
advantage of very fully. Nurses are required for 
the inspection of the homes for infants licensed under 
the act, and for advising the foster mothers on the 
health and rearing of the infants committed to their 
charge. At present all the inspectors under the 
Infants' Act are not trained nurses, but as time goes 
on it is hoped that more will be willing to come 
forward and help in this important work. 

Another branch of nursing is that of mental cases. 
The prejudice against this nursing is only gradually 
dying out, and as a general rule the women taking 
it up are not of so high a class as the general hospital 
nurse. Of late years a system of training in mental 



2i 8 A History of Nursing 

nursing with a three years' course of lectures and 
examination, has been initiated, and a register of 
mental trained nurses, male and female, has been 
established. The mental hospitals of the Dominion 
— some with 800 or 900 beds — are well equipped, 
fine establishments, and afford a very fair training 
in the care of the insane. Owing, however, to the 
fact that there is very little illness among the patients, 
the teaching of the various nursing methods is very 
difficult, and is more theoretical than practical. 
In the future the higher appointments in the mental 
hospital service will be held by nurses who have had 
general as well as mental training. A nurse inspector 
visits the mental hospitals periodically, and especially 
interviews the women patients and examines their 
accommodation. This office is combined with ttoat 
of the Assistant Inspector of Hospitals, and is carried 
out under the Inspector-General of Mental Hospitals, 
Dr. Hay, formerly assistant to Dr. MacGregor and 
on his death placed in sole charge of the Mental 
Hospital Department. Dr. Hay desires to improve 
the status of the mental nurse and attendant, and 
has instituted a course of lectures and examination on 
the basis of the medico-psychological association. 

The nursing of consumptives is carried out chiefly 
in four sanatoria. Two are situated in the North 
Island — one at Cambridge, which is entirely a govern- 
ment establishment, and the other at Otaki, which 
is connected with the Wellington Hospital. Two 
are in the South Island — at Christchurch, on the 
Cashmere Hills, and at Palmerston, South in Otago, 
and connected with the Christchurch and Dunedin 
hospitals respectively. These are for curable cases 



In New Continents 219 

only, and are nursed by a trained staff, in the case 
of the three last by probationers drafted for a short 
period from the main hospitals. In the near future 
it is probable that a scheme for fighting this dread 
disease will be set on foot, in which the assistance 
of the trained nurse will be essential in wider fields 
than in the sanatoria. 

Nurses are nearly all eager to get out into the 
world on completing their training — so much so that 
it is difficult to keep a sufficient number of staff 
nurses in the hospitals. Several of the larger ones 
make their pupils sign an agreement to remain a 
fourth year if required on the staff, after completing 
their three years' training and becoming registered 
nurses. This spirit of change and unrest is undoubt- 
edly detrimental to the better training of nurses, the 
Sisters frequently being too junior, or if they them- 
selves have sufficient experience, not being aided by 
charge nurses of full training. 

The hours for nurses' work throughout the Do- 
minion are, compared with other countries, fairly easy. 
The eight hours' system has been established since 
1898 in some of the hospitals, and by the Hospitals 
and Charitable Institutions Act in 1909, was made 
compulsory for all pupil nurses training in the larger 
hospitals. It originated with Dr. Kenny, medical 
superintendent of the Wellington Hospital, and or- 
ganised by him on the lines of engineer hours on 
board ship. Whether such hours — during which 
owing to the smaller number of nurses on duty at a 
time, the work must be rather strenuous — are of 
benefit to the nurses, is a matter for doubt. To the 
patients the stress and hurry must inevitably mean 



220 A History of Nursing 

less careful and thorough nursing, and therefore, 
less thorough training of the probationer. Fortun- 
ately the eight hours' system is not extended to the 
trained staff nurses and Sisters of the hospitals. The 
united protests of the Trained Nurses' Association 
of New Zealand were called forth at the time this 
law was passed, and with other representations against 
a measure so hampering to the work of nursing, 
succeeded in confining the law to the pupils in train- 
ing. The benefit of organisation was thus illustrated 
in a very practical way only a few months after the 
formation of the association. T 

The difficulty in this country of getting domestic 
help renders it quite necessary that nurses who intend 
to qualify for the charge of a country hospital must 
be able to cook, scrub, and wash as well as nurse. 
A matron may at any moment be deserted by her 
cook or her laundress and have to take charge of 
stove or wash-tub herself. Sometimes, too, the 
nursing work in the very distant small hospitals is 
not sufficient to justify a staff of even one additional 
nurse, and the matron must depend chiefly on the 
help of a wardsman whose special duty is the care of 
the grounds. In spite of all, however, we find 
those who stick to their work under all disadvant- 
ages and love their little hospitals. They work hard 
when necessity arises, and are on duty day and night 
when any bad case is in, indeed welcoming a bad case 
with delight. A typical hospital of this kind is the 

1 As overwork in hospitals is a grave problem in many countries, 
it seems a pity that this fortunate land should find its nurses criti- 
cal of the eight-hour hospital day. It probably only needs some 
modification as to change of shifts. — Ed. 



In New Continents 221 

Taumaranui, which is situated on the main line 
between Wellington and Auckland, and in a sparsely 
settled district. The Matron there has no trained 
assistant, and the probationer nurses she can secure 
remain only long enough to be of some use when, 
if they are any good, they go on to a training school. 
There is also a general servant and a man on the staff. 
The hospital is administered by the government. 
There are six beds and now and again eight or nine 
patients, at other times only one. The patients are 
all acute, sometimes bad accidents from the saw- 
mills, needing careful and continuous nursing, and 
in such case the matron is allowed extra assistance 
from Auckland. A Christchurch graduate, Miss 
Gill, who went there as Matron, wrote shortly 
after arrival. 

We were now ready to take patients, but none were 
forthcoming. As the mills in the district were not work- 
ing, and no one in the township was sick, our attendance 
was not required, therefore nurse and I proceeded to make 
a track for ourselves down the hill to the river. We went 
forth armed with slasher and spade, and cut and dug a 
winding path. We then set up numerous sticks with 
rags tied to them, so that we should easily find the track 
in the scrub. ... A new difficulty had arisen; who was 
to look after the acetylene gas plant, and the oil engine 
by means of which the water was pumped to the house? 
Certainly the man about the place, and he did so when I 
had one with sufficient intelligence to understand it. 
But supposing the man should take it into his head (as 
they sometimes do) to go off at a moment's notice, who 
then should work the engine and gas plant? Nothing 
for it but the Matron must learn how. This I promptly 



222 A History of Nursing 

did, and I am sure you would have laughed at my get-up, 
when, the water getting low in the tanks, I had to go into 
the engine-house and clean and start the engine. This 
was no hardship as I am fond of engines. But it was 
very dirty work, and later on when myself and a proba- 
tioner had nine patients to nurse, three of whom were 
typhoids, I really could not find time to do it . . . but I 
was sorry to give up that engine. 

Steps are now being taken to form a Nursing Re- 
serve under the new Defence Scheme for N ew Zealand 
as organised by Major-General Godley, an Imperial 
officer, on lines recommended by Lord Kitchener, 
after his visit to the Dominion, in 1910. The nursing 
reserve will be under civil control and organised by 
the Inspector-General of Hospitals. There was a 
previous attempt to form a reserve, and a Matron- 
in-Chief, Mrs. Janet Gillies, formerly Nursing Sister 
Speed during the South African War, was appointed 
to the position ; but the reserve was not formed and 
she has now retired. A new Matron -in-Chief is to 
be chosen immediately and the appointments of 
Matrons, Sisters, and nurses will follow. 

Africa.— Africa is known as the " Dark Continent,'* 
but darkness is giving place to dawn, and dawn 
with tropical rapidity to broad daylight. A powerful 
factor in this development is the trained nurse, who, 
following the flag, has found her way to the heart of 
the continent, so that in Uganda, on the shores of the 
Victoria Nyanza, there is now a hospital having a 
three years' certificated nurse as Matron, and on the 
island of Likoma, on Lake Nyassa, there is a well- 
appointed hospital nursed by certificated British 



In New Continents 223 

nurses. The same may be said of Zomba, head- 
quarters of the administration of British Central 
Africa. 

On the northern seaboard British nurses are doing 
excellent work in hospitals at Port Said, Alexandria, 
and Algiers, while at Cairo there is a large hospital, 
the Kaisr-el-Aini, with an English Matron and nursing 
staff, in which native nurses are trained. This is 
the only recognised training school in Egypt for 
nurses or midwives who are registered by the govern- 
ment. On the west coast many lives have been 
saved by the good offices of members of our profession 
in the hospitals at Sierra Leone and Lagos, and 
trained nurses have also gone inland to nurse mem- 
bers of the West Frontier Force on expeditions into 
the interior. 

On the east coast there is at Mombasa a govern- 
ment hospital, founded originally by the Imperial 
British East African Company, which was nursed 
first by religious Sisters, now by nurses sent out by 
the Colonial Nursing Association. At Tanga is 
another under the care of German deaconesses, 
while the island of Zanzibar, the metropolis of the 
east coast, has English, French, and native hospitals. 
The former is interesting, inasmuch as in it some pro- 
gress has been made in giving systematic instruction 
to native men and women in nursing. The hospital 
is maintained by the Universities ' Mission to Central 
Africa, and has a nursing staff of a Matron and five 
or six British certificated nurses, who take consider- 
able pains to train the natives who work under them. 
The value of this work is great, as the African thus 
receives instruction in habits of order, method, and 



224 A History of Nursing 

discipline, and in an appreciation of the value of time, 
which are foreign to him naturally. So far the men 
have, on the whole, made better nurses than the 
women, partly because the latter marry so early that 
few of them stay in the hospital long enough to pass 
through a full training; partly because in Zanzibar, 
as in other Oriental countries, the men are in advance 
of the women in educational development; partly 
again because the male wards are more used and so 
afford a better training ground than the female wards, 
and it would outrage national feelings to place an 
unmarried woman in charge of men's wards. Never- 
theless some of the girls have proved themselves apt 
and trustworthy pupils, and, given equal advantages, 
would no doubt become as proficient as the men. 
They have many of the characteristics essential in a 
good nurse, being gentle, kind, sympathetic, dextrous 
with their hands and quiet in their movements. 
They are also, as a rule, devoted to children. On 
the other hand they do not like performing parts of 
the work which they consider menial, and they have 
not much sense of responsibility; neither have they 
much stamina. 

Two reasons may be assigned for the dislike of 
the natives to menial work: they have too recently 
emerged from slavery and many have had personal 
experience of the horrors of the slave caravan. They 
have a profound dislike of doing slave work, and a 
common objection is, "I am not a slave." Then, 
too, as the right hand takes the place of a spoon 
among the Swahilis they are very particular as to 
its cleanliness. So far as practical work goes, both 
native men and women in Zanzibar have learned 




English Hospital, Zanzibar; Miss Breay and Miss Brewerton in the 

background 



In New Continents 225 

enough to make them very useful. For instance, 
they can polish instruments and prepare for an opera- 
tion in a way which would be creditable in an up-to- 
date London hospital. Their theoretical work has, 
so far, lagged behind the practical, and there are at 
present no nursing text-books in the Swahili language. 
The influence of the training given in this hospital 
is far-reaching, as many of those who receive it re- 
turn to their tribes up-country, and thus carry their 
nursing knowledge to villages where no European 
is stationed. 

No account of the hospital of the Universities' 
Mission in Zanzibar would be complete without 
mention of the gracious and cultured woman at 
whose instance it was built. The mission had had 
many devoted nurses, but their work was done under 
difficult and unsuitable conditions. It was owing 
to the initiative and the strong representations made 
in 1890 by Miss Emily Campbell, a nurse possessed 
of rare charm and professional skill of a high order, 
combined with absolute devotion to the sick, — a saint 
in the making, — that the mission owes its hospital, 
in which her successors, notably Miss H. Brewerton, 
for many years Matron, Miss S. A. Whitbread, now 
gone to her rest, Miss M. Brown, Miss C. L. Saunders, 
and many others have rendered the most devoted 
service to patients of all colours and creeds. Miss 
Campbell herself did not live long enough to see the 
completion and opening of the hospital, and her 
death, after two years' work in the mission, was an 
added urgent proof of its need, for she died u of sheer 
overwork, nursing single-handed a poisonous case 
in a house eminently unsuited for such a purpose. 

VOL. IV. — IS 



226 A History of Nursing 

. . . We could not but be influenced, every one of 
us" said the Reverend Spencer Weigall at a meet- 
ing of nurses in London, "by having a character of 
such extraordinary beauty among us. 

Another heroic pioneer worker for the sick in 
Zanzibar was Mme. Chevalier, who gave devoted 
service in connection with the French mission. 
Mounted on her beautiful white donkey, she was a 
well-known and notable personality on the island, 
where she lived for over a quarter century without 
returning to France, making the lepers her special 
care. Mention must also be made of a midwife, 
who is at work in the town of Zanzibar, under the 
auspices of the Lady Dufferin Fund. 

We must turn to South Africa, however, to find 
nursing organisation in an advanced condition. 
Nurses there were the first to secure legal status 
and registration under state laws. This was con- 
ferred upon them by a section of the Medical and 
Pharmacy Act of 1891. The administration of the 
act is carried on by the Cape Medical Council. 

It was largely to Sister Henrietta of Kimberley, 
an English nurse and daughter of a clergyman, the 
Rev. Henry Stockdale, that nurses in South Africa 
owe the honourable distinction of being the first to 
be registered by Act of Parliament in any country. 
Sister Henrietta attended the London Congress of 
Women, in 1899, and there told the nurses, assembled 
in their first international meeting, how, when the 
new medical bill was before the Cape parliament, 
the trained nurses of the country, — a little band of 
some sixty-six women then, now quite an army, — 
petitioned almost unanimously for a place on the 



In New Continents 227 

register and for state control of education. With 
much care and forethought clauses were drawn up 
providing for the registration of foreign trained nurses 
and state examination and registration of the colo- 
nial-trained. A section also deals with midwives. 
The nurses gained their wish, and after this length 
of time, the act has on the whole worked well. Sister 
Henrietta continued her life of active usefulness for 
many years; took a prominent part during the siege 
of Kimberley and afterwards, in organising the care 
of the wounded and sick, and died, full of good deeds 
and honours in 19 10. 

This first registration act gave a year of grace 
during which time all nurses holding hospital cer- 
tificates could register. One year's training was at 
first accepted. In 1892 the minimum was set at two 
years, and finally, in 1899, three years in a hospital 
of not less than forty beds was fixed as the minimum, 
and the medical council set a syllabus of subjects for 
examination and fixed the lines of training at much 
the same as in the best English hospitals. Medical 
men delivered lectures preparatory to examination, 
and conducted written and oral examinations in the 
different centres. 

South African nurses have found, however, that 
there is a disadvantage in having no nurse sitting 
upon the council, and liberal physicians have learned 
the same thing. In 1904, a report on the act and its 
workings was sent to the International Council of 
Nurses by Dr. Moffat, then resident surgeon at the 
Somerset Hospital in Cape Town, in which he said : 

The legislation affecting nurses is gradually improving 



228 A History of Nursing 

the education of nurses and raising the standard of pro* 
fessional knowledge. 

I venture to suggest, even though I may tremble at 
the thought of what our Council would say to such a 
thing, that some at any rate of the members of the 
Council should be trained nurses, who could discuss and 
vote on nursing questions. Probably in time there will 
be a Nursing Council; some of these should be trained 
nurses. At present the members of our Council are all 
men. 

In the same way, I think the examination should be 
conducted in part by trained nurses. 

The great gain which would follow from the two latter 
additions does not need to be pointed out. 

In 1899 registration of trained nurses was enforced 
by act of Parliament in Natal, and in 1906, in the 
Transvaal under the Transvaal Medical Council. 

Some of the South African hospitals are fine build- 
ings, and in a number there are training schools of 
excellent standing. Certificates are no longer granted 
by individual schools, as the medical council now 
issues its own by the authority taken from the 
hospital authorities and vested in them. With the 
development of the country and the advance of 
nursing, we shall hope to see nurses placed on the 
examining board, but this will perhaps not come 
until women are enfranchised. 



CHAPTER V 

NURSING SISTERS OF THE ORIENT 

India. Among Miss Nightingale's writings some 
of the most remarkable evidence of her genius is to be 
found in articles published in her later years on the 
problems of life in India, as affected by government. z 
In an earlier volume 2 we have cited her plea for vil- 
lage sanitation in that country, but had not then seen 
those writings in which she analyses the whole social 
order of India, tests every detail of land ownership, 
taxation, social, and economic organisation in the 
clear fire of her interpretative intelligence, exposes 
every weak, wrong, or oppressive point with her 
vivid, flashing gift of demonstration, and constructs 
item by item, with a rare statesmanship and a prac- 
tical force all her own, the programme by which 
alone the real sources of famine, pestilence, and 
misery could be reached. Papers of an intellectual 
outlook and human insight so broad and deep should 

1 "The People of India," Nineteenth Century, August, 1878; "The 
Dumb shall Speak and the Deaf shall Hear, or the Ryot, the Zemindar, 
and the Government," Journal of the East India Association, London, 
1883; "Our Indian Stewardship," Nineteenth Century, August, 1883, 
"Health Missioners for Rural India," in India, (a magazine), 
London, 1896. 

2 A History of Nursing, Vol. II. 

229 



230 A History of Nursing 

never be allowed to fade in obscurity. They should 
be in every public library. Had they been written 
by some cabinet minister they would stand, richly 
bound, on the shelves of every man in public life, 
even if their recommendations were not followed or 
even read. Her mastery of enormous official detail 
and technical, statistical facts as shown in these 
papers is amazing, and suggests that the greater part 
of her later years must have been given to an intensive 
and laborious study of Indian affairs. This was the 
hard work which filled her time and left her in her 
invalid's room no leisure, for she continually re- 
ceived masses of official documents, such as few other 
persons ever saw, and which were sent for her con- 
fidential analysis and commentary. We do not know 
exactly what results followed these labours. Here 
she launched far forth from nursing subjects to deal 
with Imperial policies, yet every flash of her mind 
showed that her basic thought was of health — the 
health of a nation and the happiness to a race that 
could result from it. 

The earliest efforts to transplant English nursing 
into India came through the missions. To describe 
their gradual advance is beyond our province and 
our powers. The nurses who shared in it, pioneers 
in the fullest sense, were sent ready trained from the 
mother countries, and we must be content to begin 
this record with the first work in training native 
women. 

Whether simple human service to others' needs 
should be made the vehicle for controversial pro- 
paganda is a question which must be answered by 
each one as he sees the light, and in how far the 



India 231 

work of medical relief may be developed when allied 
to any doctrine or dogma or to the tenets of any one 
church is also debatable. Yet the mission spirit 
has always led the way to service in the hardest, most 
dangerous places long before any one else was ready 
to go, and during two thousand years we have seen 
medical missions breaking the ground for a new 
civilisation by their heroic and devoted labours. 
The Hindu papers complained that the most powerful 
weapon used by the Christians to lay hold of the 
hearts of the Hindu women was the Zenana hospital. 
They perhaps felt that their people were being alien- 
ated from sacred tradition. On the other hand, the 
love and care expressed in mission work were always 
lavished especially on those downtrodden and inferior 
beings whose sex or caste gave them, under the old 
dispensations, little to hope for in heaven or else- 
where, so why should they remain bound by the 
conventions of ancient historical religions which, 
however beautiful in ideals, had become in practice 
full of negations for workers and for women? The 
missionaries entered, inspired by a purpose ever 
fresh, pure, and strong, and consecrated all their 
powers to the task of awakening soul and spirit. 
The medical woman and the nurse were irresistible 
to the neglected proletariat to whom they ministered, 
and suspicion and aloofness melted away before 
their skilled, tender handling of poor diseased bodies. 
The first project for bringing medical care and 
nursing on a national scale to the people of India, 
and of providing a far-reaching and autonomous 
system by which centres of teaching and training 
might be multiplied, according to local needs, was 



2^2 A History of Nursing 

the work of the Countess of DufTerin, during her 
stay in India as "first lady in the land." Her plan, 
built upon large and comprehensive lines, was de- 
veloped with wisdom and foresight, and shines 
brightly in that tale of upbuilding and conservation 
which goes to balance the long dull histories of de- 
structive forces. How it came into being is best 
told in her own words 1 : 

When I was leaving England, Her Majesty the Queen- 
Empress drew my attention to the subject [of supplying 
medical aid] and said that she thought it was one in 
which I might take a practical interest. From that time 
I took pains to learn all that I could of the medical ques- 
tion in India as regards women, and I found that, though 
certain great efforts were being made in a few places to 
provide female attendance in hospitals, training schools, 
and dispensaries for women, and although missionary 
effort had done much, and had indeed for years been 
sending out pioneers into the field, yet taking India as 
a whole, its women were undoubtedly without that med- 
ical aid which their European sisters are accustomed to 
consider as absolutely necessary. I found that even in 
cases where nature, if left to herself, would be the best 
doctor, the ignorant practice of the so-called midwife 
led to infinite mischief, which might often be character- 
ised as abominably cruel. It seemed to me, then, that 
if only the people of India could be made to realise that 
their women have to bear more than their necessary 
share of human suffering, and that it rests with the men 
of this country and with the women of other nationalities 

1 See The National Association for Supplying Female Medical 
Aid to the Women of India. By the Countess of DufTerin, reprinted 
from the April Asiatic Quarterly Review. Calcutta, Thacker Spink 
& Co., 1886. 



India 233 

to relieve them of that unnecessary burden, then surely 
the men would put their shoulders to the wheel and would 
determine that wives, mothers, sisters, and daughters de- 
pendent upon them should, in times of sickness and pain, 
have every relief that human skill and tender nursing 
could afford them ; and we, women of other nationalities 
... we surely too should feel a deep sympathy with 
our less fortunate sisters and should, each one of us, en- 
deavour to aid in the work of mitigating their sufferings. 
I thought that if an association could be formed which 
should set before itself this one single object, to bring 
medical knowledge and medical relief to the women of 
India, and which should carefully avoid compromising 
the simplicity of its aim by keeping clear of all contro- 
versial subjects and by working in a strictly unsectarian 
spirit, then it might become national, and ought to com- 
mand the support and sympathy of every one in the 
country who has women dependent upon him. 

With this idea, Lady DufTerin took her initial 
steps and her plan was warmly received. A pro- 
spectus was drawn up and published in various lan- 
guages all over India. The association was named 
the National Association for Supplying Medical Aid 
to the Women of India; and as the money for it 
was collected, it was credited to the "Countess of 
DurTerin's Fund." The press and public were ready 
for it. Few objections were heard. One, however, 
put forward by conservatives was, that the women 
of the country did see medical men professionally, 
to which Lady Dufferin answered that this was only 
in the last extremity, when the medical man admitted 
to a Zenana entered with his head in a bag, or re- 
mained outside the purdah, feeling his patient's pulse, 



234 A History of Nursing 

but unable to examine her. (A medical missionary 
in India knew of a string being tied around the 
patient's wrist in a critical case and the doctor, in 
another room, given the string at its other end to 
feel the pulse!) Said Lady Duflerin in discussing 
the objections: 

Others simply state that the women do not want 
doctors at all, and that, therefore, any scheme for giving 
them medical relief is unnecessary and quixotic. To 
refute an argument properly one should understand it, 
and I confess I do not understand this one. It seems to 
me simply to point to the total abolition of doctors and 
to the extinction of medical science altogether. ... But 
it is true that in India, as elsewhere, men have all that 
they require in the way of medical advice, while the 
women here have not, and the object of this scheme is 
to remedy an occasional injustice. If women do not 
want doctors, then men can do without them. . . . 

The criticism that the association was "official" was 
also made, and to this Lady Duflerin, after pointing 
out that it received no government aid, said : 

We are honestly desirous that it should become un- 
official and truly national, and we are making every effort 
to place it upon a really popular basis. We are merely 
birds of passage here, and if the work is to go on and 
prosper it must be gradually taken out of our hands and 
be undertaken by those who live in the country and for 
the benefit of whose women it has been begun. 

The affairs of the association were managed by a 
central committee, of which the Countess, during 
her stay in India, was president. Branches were 



India 235 

connected with the central body, and by this articu- 
lated form continuous growth was made possible, 
to include and cover the whole country. Each branch 
association was, for all financial and executive pur- 
poses, entirely independent, but was expected to 
adhere to the principles of the national association, 
and was asked to contribute a small percentage of 
its receipts to the central fund. Public meetings 
were held to explain the purpose of the fund and to 
arouse interest. Existing institutions and organisa- 
tions having the same medical work in view were 
encouraged to affiliate with the association, their full 
independence remaining unimpaired. This arrange- 
ment was meant especially to affect mission societies. 
Such affiliated groups, it was explained, might obtain 
grants from the association for special purposes, 
while all would benefit by having a common centre 
of reference and information. The objects for which 
the association was established were set forth in its 
publications as being: 

I. — Medical tuition, including the teaching and train- 
ing in India of women as doctors, hospital assistants, 
nurses, and mid wives. 

II. — Medical relief, including the establishing under 
female superintendence of dispensaries and cottage hos- 
pitals for the treatment of women and children; the 
opening of female wards under female superintendents in 
existing hospitals and dispensaries; the provision of 
female medical officers and attendants for existing female 
wards; and the founding of hospitals for women where 
special funds or endowments are forthcoming. 

III. — The supply of trained female nurses and midwives 
for women and children in hospitals and private houses. 



236 A History of Nursing 

The national association, as above outlined, was 
organised in August, 1885. " Its one aim and aspira- 
tion," wrote its foundress, "is to bring to the women 
of India better health, freedom from unnecessary 
pain, and all the comforts and alleviations which 
science has discovered and which the ministering 
hand of doctor or nurse can supply. ..." 

In an article written upon the work, Lady Dufferin 
recounted some of the difficulties met : 

A last difficulty is that we start our medical work with 
scarcely any supply of doctors, midwives, or nurses to 
hand. There is not one single native female doctor 
ready, though about forty are now being trained. [The 
number of such students is rapidly increasing.] A few East 
Indian ladies have been educated at Madras and have 
all the necessary qualifications [to some of these, posts 
were offered], but the country itself is, undoubtedly, un- 
able to supply even the present demand for well-educa- 
ted doctors, well- trained nurses, and efficient midwives. 

In regard to the missions, she thus explained the 
principles of the association : 

The national association cannot employ missionaries, 
nor can it provide hospital accommodation in which it 
is intended to combine medical treatment with religious 
teaching. It may, in certain cases, be glad to avail itself 
of medical missions as training agencies, and may oc- 
casionally attach an assistant to a mission dispensary. 
[For further training.] But in such cases it would have 
to be clearly understood that the assistant's duty would 
be strictly confined to medical work. No officers in the 
employ of the national association can be allowed to 
exercise a missionary calling. . . . The national associa- 



India 237 

tion cannot undertake to provide funds for the travelling 
expenses or establishment of medical missionaries. 

While defining the purely humanitarian character 
of the work in thus standing aside from doctrinal 
teaching, the intention of its foundress was to unite 
all bodies in the philanthropic work common to all, 
and not to intervene where the mission already oc- 
cupied the ground, except in towns so large that there 
was room for a second medical establishment, or 
when the demand came from the people of a locality. 
She wrote: 

The function of the central committee is to act as a 
link between all branches, to collect information, give 
advice, and assign grants-in-aid. It is in direct com- 
munication with those parts of the country where no 
branches have been formed, and with those Indian princes 
who interest themselves in the movement and who are 
endeavouring to promote its objects within their own 
dominions. Its duty is to study the information re- 
ceived, so that it may understand the wants of different 
localities; to see in what direction it can best help each; 
and to administer the funds at its disposal for the benefit 
of the most useful institutions and the most needy 
districts. 

The central committee has also the responsibility of 
directing the policy of the association ... to consolidate 
and to improve the position of the society. x 

Though in no way an arm of the government, it 
being understood that the employees of the associa- 

1 From A Record of Three Years 1 Work of the National A ssocia- 
tion for Medical Relief to the Women of India, August, 1885 to 1888, 
by the Marchioness of Dufferin and Ava. Hatchard, London, 1889. 



238 A History of Nursing 

tion were not employees of the government, a certain 
official recognition was granted to the medical women 
and others employed by the association, and there 
was also a certain amount of direct co-operation by 
the Surgeon- General and the chief medical officers 
of the provinces. The whole amount subscribed 
to the fund, even in the first few years, was a princely 
sum. From the subscriptions received, a certain 
amount was set aside as an endowment fund, and 
at the end of three years' work enough had also been 
set aside from income to endow six medical, twelve 
nursing, and two hospital assistant scholarships. 
Besides this, annual grants were made to medical 
staffs and nursing expenses in a number of cities, 
as well as a great deal of current outlay of varied 
kinds. 

The impetus and definite help given by the fund 
was general and varied, and to deal fully with its 
extent would far overpass our bounds. In medical 
relief in 1889, twelve hospitals for women and fifteen 
dispensaries, most of which were officered by women, 
were more or less closely connected with the associa- 
tion. Many were the new enterprises, private and 
provincial, that responded to the stimulus thus given, 
and many were the localities that undertook the 
maintenance of some branch of relief under the fund. 
Ever watchful of the best development of her plan, 
Lady Dufferin wrote in 1888: 

I should like in this place to remind those who have 
undertaken to benefit their state or their district by es- 
tablishing one of these institutions, that they must think 
of the future as well as of the present, and that they must, 



India 239 

year by year, send to one of the medical schools girls 
from their own neighbourhood, to study medicine, to 
become compounders, nurses, and dhais, so that the 
hospitals they have started may never have to be closed 
for want of female officers to direct them. 

She wrote further: 

I believe the teaching of midwifery to be the most im- 
portant and the most urgent work we have to do, for 
this science is grievously misunderstood by the ordinary 
dhais of the country. Few people know the dreadful 
cruelties perpetrated by these women under the guise 
of professional aid, while those who suffer at their hands 
are too ignorant of any better treatment to resent their 
malpractices. . . . Part of the treatment, before the birth 
of the child (as shown in official reports) consists in 
kneading the patient with the foot and stamping upon 
her hip joints, while in extreme cases a pole is placed 
across her, the attendants resting their whole weight on 
either end. 

The details are often too painful to repeat, but, 
as leading characteristics, common to most parts of 
India, 

there is the unhealthy room, remarkable for the unsani- 
tary nature of its arrangements; there are the charcoal 
fire, the absolute lack of ventilation, and the crowd of 
spectators; there is the extreme and accumulating dirt, 
and added to all this the further danger attending the 
ministrations of the ignorant or the careless or the vicious 
dhai. Nor can we, in the case of Indian women, comfort 
ourselves, as we are apt to do, with the idea that they 
lead a more natural life than Europeans and, therefore, 
suffer little at childbirth. The very contrary is the case* 



240 A History of Nursing 

The lives led by all but the very poor are most unnatural, 
and as they marry unnaturally young, they suffer more 
at the time, and are much more liable than older women 
would be to injuries causing lifelong suffering. l 

The work of teaching midwives and nurses, most 
arduous and difficult as it was, went on, at first slowly 
— then with gratifying steadiness ; the Dufferin Hos- 
pital at Nagpur was the first one for women and 
children in the central provinces. It is impossible 
for us to mention all the branches and work under- 
taken, but the map of India in the reports of the 
association, showing all the centres of work under 
the fund in red, is a revelation, while from year to 
year the beneficent results of its activities are more 
widely extended. The yearly reports 2 should be 
studied for the most recent information. 

In closing her report, Lady Dufferin said: 

It is a sense of obligation . . . that I wish to instil into 
the minds of men throughout this country. I want 
them to look upon the provision of medical aid for their 
mothers, wives, and daughters, as a positive duty, and to 
give not only money, but time and talents and personal 
labour to procure it for them. ... If relief is to be 
brought not to tens, but to hundreds of thousands of 
Indian homes, as it should be, then it is not one society, 
or a certain number of single individuals, who can ac- 
complish such a task. It is the determined attitude of 
the men of this country which must do it. It lies with 
them to give the women relief in suffering. . . . 

1 From A Record of Three Years' Work of the National Associa- 
tion for Medical Relief to the Women of India, August, 1885 to 1888. 
by the Marchioness of Dufferin and Ava. Hatchard, London, 1889, 

a Printed at the Bombay Gazette Electric Printing Works. 



India 241 

The first regular training school in India for the 
systematic instruction of native pupils in medical 
and surgical nursing, as well as midwifery, was es- 
tablished in 1886 by the Bombay branch of the 
Countess of Dufferin's Fund in connection with the 
Cama Hospital in Bombay. It is a civil institution 
under government management and is solely for 
women and children of all castes and all denomina- 
tions. Two English physicians and a staff of Eng- 
lish nurses opened the work of the hospital, but the 
training school dates from the appointment, a little 
later in the same year, 1886, of Miss Edith Atkinson, 
as lady superintendent. Trained at the York 
Road Hospital in England, she had gone to India 
in 1884 and had served in St. George's and other 
centres. An exceptionally able and sympathetic 
woman, she gave a whole-hearted devotion to her 
work, and died in 1905 after nineteen years spent in 
the training school. Two auxiliary institutions are 
now allied to the Cama, both the gifts of wealthy 
Indian gentlemen and named after them — one an 
obstetrical hospital, the Allbless, and the other a dis- 
pensary for women and children, the Iaffer Suleiman. 
These are entirely in charge of women physicians. 

The nurses' training, at first one year, was ex- 
tended to one and a half, and in 1905 brought up to 
the three-year standard. Though the staff nurses 
and hospitals are supported by the government, the 
training school is still kept up by the DufTerin Fund. 
It was at first impossible to get native women to 
leave their homes for more than a year, but they 
learned to do so readily, and, between 1887 and 191 o, 
220 pupils had been trained and seven had had six 

VOL. IV. — 16 



242 A History of Nursing 

months midwifery as well. In the year last men- 
tioned, Miss S. Grace Tindall, the lady superinten- 
dent in charge, wrote: 

Our pupils go into all parts of India and often return 
to their old school in positions of trust. I have former 
pupils as charge nurses in the civil hospitals of Maymyo, 
Karachi, and Moulmein, and have placed native nurses 
in charge of female wards in Amritsar and elsewhere. I 
am asked to fill more vacancies than I can possibly 
supply, showing that our nurses are appreciated. 

Miss Tindall was trained in England, and had had 
wide experience at home and in Egypt before coming 
to India. Active in organisation, she was chosen 
first president of the Trained Nurses Association of 
India when it was formed in 191 1, and under her 
guidance the school advanced in development; 
teaching was thoroughly organised, and lectures 
given in English and in the native "vernaculars." 
The nurses wear white without distinction of class. 
In the lecture-room of the school are tablets whereon 
are placed the names of all who receive certificates. 

One of the earliest pieces of pioneer nursing work 
was that of the Zenana Bible Medical Mission, which 
has aimed both at providing English trained nurses 
for the needs of the medical service, and at training 
the native women as nurses. Its nursing field was 
taken up in 1882, when Miss Marston came with her 
sister, Dr. A. Marston, to the hospital at Lucknow. 
She, however, was transferred within the year to the 
Zenana work. In 1883, two trained nurses, Miss 
Gregory, who was trained in Manchester, and Miss 




1 I 

so 



India 243 

Roper, were sent out. The latter was placed at 
Lucknow, then the only hospital of the mission, 
while the former studied the vernaculars in prepara- 
tion for the expected opening of a second hospital in 
Benares. When this new hospital was opened in 
1888, Miss Gregory began the training of native 
women there. Hers was a varied and useful service, 
for at the time this was written she was still connected 
with the hospitals of the mission, sometimes directing, 
sometimes helping with the nursing departments, and 
always leading the way to new and improved methods. 

Other nurses in the training work have been 
three from the Manchester Royal Infirmary, Miss 
Bowesman, Miss Riley, and Miss Grant; Miss 
Creighton from the Illinois school in Chicago; Miss 
Bostrop, a Dane; Miss Watson, trained in Liverpool, 
Miss Wright, in Derbyshire, and Miss Pearse, in 
the Edinburgh Royal Infirmary. Under these women, 
the training was brought up to an organised three 
years, study and examinations arranged, and text- 
books translated into the Persian and Roman Urdu. 
The mission has several hospitals. The first Indian 
probationer to take the full course here was Hermina 
Caleb, who graduated in 1897. Although she soon 
married, she studied pharmacy and remained at 
work in one of the hospitals as compounder until 
1904. Of forty-odd nurses trained in ten or more 
years, nineteen married almost at once, which does 
not look as if India would be speedily overstocked 
with nurses. 

Miss Creighton has told of an incident of plague 
nursing under this mission, which shows a high degree 
of fortitude in our Indian sisters: 



244 A History of Nursing 

In 1902, when the plague was at its worst in Lucknow, 
we built a plague camp. The huts, made of grass, were 
large enough for two patients and, as it was intended for 
Zenana women, we had an enclosure made of reeds around 
it. I shall never forget the day when I asked for volun- 
teers from among our Indian nurses for this camp. I 
could only give them two days to think about it, and when 
I gathered them all together and asked who was willing 
to go, making it very plain to them that perhaps they 
would never return, out of the twelve four spoke and said : 
"We will take our lives in our hands and go." They 
made all preparations in case they should not return, 
and, taking their oldest clothes in bundles, we silently 
walked to camp. For months they were in the camps, 
cut off from every one, and what they went through 
would have made many an English heart faint. It was 
not only the being in a lonely place with the dead and 
dying; many times robbers came their way, with their 
strange custom of imitating the cries of wild animals. 
A gang went through the field one night between eleven 
o'clock and midnight, when I was in the camp. They 
imitated jackals until the field seemed full of them. In 
another camp, a native nurse, the only one on night duty, 
was attacked by a robber. Although he seized her by 
the throat, she succeeded in driving him off and stayed 
at her post until the morning. 

The Sisters of All Saints took an important part 
in developing Indian nursing. In 1884, they took 
charge of the European General Hospital, Bombay, 
and a year later of St. George's, the intention of the 
authorities being that their work should form a 
centre from which well-trained nurses might be sup- 
plied to other institutions. In 1907, St. George's 
formed its own staff, but in the Jamsetjee Jejeebhoy 





•^ £ 



India 245 

Hospital in Bombay among others, the Sisters con- 
tinued to train not only Europeans, but also numbers 
of Parsee and Indian pupil nurses. St. George's 
formed a Nursing Association, and chose Miss C. R. 
Mill, from the Dundee Royal Infirmary, as lady 
superintendent. Miss Mill, who joined the Inter- 
national Council of Nurses at its formation, to re- 
present India, had had five years' experience in plague 
nursing in Poona, under the government, as well as 
ordinary work in England. St. George's training 
is for three years, while the nurses sign for four, 
spending the last on the private staff. 

The North India School of Medicine, founded at 
Ludhiana in 1894 by Dr. Edith Brown (England), 
has done yeoman's service in early training efforts. 
Dr. Brown wrote: 

Nineteen years ago when I came out to India, there 
was nothing which could be called nursing in the Woman's 
Hospital, and it was exceedingly difficult to get any woman 
or girl of good family to enter a course of training. Sanit- 
ary work was objected to as "sweeper's work" and per- 
sonal care of the patients as "ayah's work," while there 
was no appreciation of the necessity for accuracy or 
method in the giving of medicines and food. Some of 
the orphan girls were sent from the orphanage to learn 
nursing, the reason for their coming being such as the 
following: 

"As she has only one eye and cannot be a teacher, " 
or, "as she is so disobedient, I can do nothing with her" 
or, "as she has such a bad temper that she cannot be 
trusted in the school, because she beats the children." 

Further, they were sent to us at sixteen years of age, 
if at all, as it was "not worth while to keep them longer 



246 A History of Nursing 

in school, " and when they came they were physically 
not strong enough for such work — were afraid of being 
awake at night, and, if a patient were specially ill, were 
actually afraid to go near her alone at night, so it may be 
imagined our difficulties were great. After some time 
we got some European girls and a few girls of good family 
to take up the work, following the example of those at 
home, and this gave a certain amount of prestige which 
has made it easier. The presence of English nurses in 
India, too, has had much influence in altering the general 
attitude towards the profession. In 1900, we were 
joined by Sister Winifred Thorpe, whose influence has 
been great in India, and under her superintendence our 
course of study was raised from two to three years, and 
a higher standard of preliminary education was required. 
Nurses who have gone from our school have had respons- 
ible posts in government hospitals in Simla, Lahore, and 
Amritsar, and in many mission hospitals in North India. 

The Albert Edward Hospital of Kolhapur took its 
first class of native women to be trained as nurses in 
1890. They were hardly able to read, yet did excel- 
lent work, and their example was not without influ- 
ence among high-caste women. In 1905 another class 
was formed and a better educated body of women 
then came forward. Ten of them, superior women 
in every way, completed the course of training. 

The Canadian Presbyterian Mission built its first 
women's hospital at Indore, Central India, in 1 891, 
and worked slowly toward nursing efficiency. For 
five years the nursing of all the patients had to be 
done by their friends, but, in 1896, a graduate of the 
Toronto General Hospital, Miss Harriet Thomson, 
came into the mission, and, in 1898, the first class of 



India 247 

two probationers was started, with a native head 
nurse trained in a mission hospital at Benares. One 
of the two first probationers died. The other com- 
pleted a three years' course, took her certificate, and 
was appointed as head nurse in a native state hos- 
pital. The uniform is a pink and white check with the 
white draperies of the country. The mission has also 
a hospital in Dhar. Canadian trained nurses have 
done excellent work in these centres. 

The American Evangelical Lutheran Mission 
opened its hospital at Guntur, South India, in 1897. 
Many obstacles had to be surmounted before native 
prejudices to nursing duties were finally overcome. 
Well-educated girls regarded such duties as very de- 
grading, conflicting with ideas of caste, and it was 
finally decided to open a training school for European 
and Eurasian candidates as an example. After 
laborious introductory work the school was started 
in 1899 with three pupils. Beginning with two years, 
the course was soon extended to three, and a care- 
ful arrangement has been satisfactorily followed 
for teaching anatomy and physiology, surgical and 
medical nursing, materia medica, and midwifery in 
class and lecture, with practical demonstrations and 
classroom equipment. So well did all progress, that, 
in April, 1 9 10, on the day after the annual commence- 
ment, an alumnae association or league was organised, 
members of five classes being present. Miss K. 
Fahs, then the superintendent (University of Penn- 
sylvania Hospital), to whose ability and earnestness 
most of this result was due, wrote: "We have finally 
overcome the native prejudice to nursing, and now 
have more applicants than we can take. We have 



248 A History of Nursing 

conquered the unwillingness to sweep, and the op- 
position to all those duties once considered degrading. 
The nurses do everything for the patients, and we do 
not allow a sweeper to enter the wards. It was up- 
hill work, but we have succeeded, and feel proud of 
our success." 

The English Baptist Zenana Mission had its first 
English nurse at the hospital at Palwal, but this 
service was more or less tentative until the arrival 
in February, 1905, of Sister Duff, who held London 
Hospital and other certificates and had been for three 
years in plague work in Bombay, Poona, and Ahmed- 
nagar. She rounded out the course of instruction 
and added class work in special practical nursing. 
The next English nurses who came to the work con- 
tinued to build up, and progress was marked and 
encouraging. The course developed to three years, 
and Indian girls were trained into excellent nurses, 
yet when they first came, "beds, sheets, and clean- 
liness were unheard-of luxuries and punctuality an 
uncoveted virtue." In the various hospitals of the 
Baptist mission trained nurses are paid as high 
salaries as teachers, and this gives them standing in 
Indian eyes. 

From the United Free Church of Scotland Mission 
with its Mure Memorial Hospital at Nagpur comes 
the report: 

The young girls over seventeen who are taken are ir- 
responsible and require much supervision. As a rule, 
they marry at or before the end of their training. The 
uneducated women, if intelligent and suitable, make 
good nurses, though to train them is a task needing much 



India 249 

time and patience. Our Matron and nurse-in-charge is 
a girl of our own training, an exceptionally good nurse, 
and quite capable of directing and superintending the 
juniors. She has now been with us for several years and 
is still, at twenty-five, unmarried, so is an exception to 
the general rule. During the three years, the subjects 
taught are elementary physiology, bandaging, surgical 
instruments, sick-room cookery, simple compounding, 
and midwifery. Examinations follow each course of 
lectures and a certificate is given if merited. The un- 
educated women have a longer training and less class 
work than the others. Some of our nurses have taken 
good posts in other hospitals. 

The simple narratives of these pioneer efforts show 
what an immense process of upbuilding is going on 
in India under the faithful hands of nurses from many 
countries. The constant aim and efforts of the nurs- 
ing superintendents there tend toward a practical 
working uniformity or standardising of training. 
To this end there has been formed the Association 
of Nursing Superintendents of India, first proposed 
at a conference in 1905 and agreed upon in 1907, and 
this body has called into being the Trained Nurses' 
Association of India. A journal for self-expression 
and as a carrier of professional communications, 
called the Nursing Journal of India, was successfully 
launched in 1910, and with this organ at command 
and the quickened interest that results from co- 
operative effort, great impetus forward is at hand. 
The Journal was first edited by Mrs. Etha Butcher 
Klosz, from the Johns Hopkins. 

The question rife in hospital work all over the world 
— of uniformity in training — was definitely taken up 



250 A History of Nursing 

in 1909, when, at a conference of the India Medical 
Mission Association, a resolution was passed author- 
ising Miss E. MacDonnell (superintendent of the 
South Travancore Medical Mission of the London 
Missionary Society and trained at the Edinburgh 
Royal Infirmary) to inquire into and report upon this 
subject. Miss MacDonnell' s work was arduous, 
for the standard of training for native Indian nurses 
was to be itemised and compared, and the proposition 
of two levels — one for the hospitals under the govern- 
ment and another for those under the missions — con- 
sidered. Her committee sent out a questionnaire in 
1 910 and, to focus replies, put forth a tentative pro- 
posal for arriving at a uniform standard for the mis- 
sion training schools. Briefly, this called for an 
admission age not under eighteen, good vernacular 
education (about seven years of schooling) with some 
knowledge of English, regular entrance periods twice 
yearly, a three years' course with the subjects laid 
down for each year, and an agreement on text-books 
for study. Miss MacDonnell further wrote : * ' It was 
felt that it would very materially help in raising the 
standard of nursing in mission hospitals throughout 
India if a nursing diploma were granted, not by each 
unit, but by the I. M. M. A. who, through its local 
branch, would appoint examiners annually." 

The direction of effort of nurses in India is further 
shown by an editorial in the March Journal, 191 1, 
closing with these words: "We are working towards 
registration of nurses, i.e., government recognition 
of the status of a trained nurse. ... To get registra- 
tion, we must have a uniform standard of training." 

The first definite example of incipient registration 







Miss M. E. McDonnell and Nurses at Neyoor 



India 251 

is shown in the Presidency of Bombay, where a cen- 
tral nursing board was formed in 1909-10 under the 
Bombay Presidency Nursing Association, to stand- 
ardise training, set examinations, and give one cer- 
tificate to graduates from all the hospitals in its 
territory. The first examination held under the 
auspices of this body was described critically, by 
Miss Tindall, in the Nursing Journal of India for 
November, 191 1. Tentative though it may seem, 
this must be regarded as an important event, mark- 
ing a beginning of far-reaching changes. 

Private nursing in India is largely confined to the 
foreign colonies there, and is chiefly carried on 
through associations, of which that called Lady 
Minto's Indian Nursing Association is the largest, 
most recent, and also the most comprehensive, in 
that it recognised and made use of existing organisa- 
tions, amplifying all, and extending their services. 
It was projected in 1906. In the report for 1909, 
Mrs. Jessie B. Davies, Lady Superintendent of a staff 
comprising three assistant superintendents and forty- 
eight Sisters, gave some details, as follows: 

It may be interesting to note that, under special 
conditions, nurses are supplied to Indian ladies and 
gentlemen, the conditions being that the number of 
nurses unemployed in the home is more than sufficient 
for the needs of the registered subscribers, that the 
applicants must be living in European fashion, and 
able to provide suitable food and accommodation for 
the nurse, that only those nurses who volunteer 
should be sent, and that a special fee should be charged 
in all such cases. 

All nurses engaged for service in India are carefully 



252 A History of Nursing 

examined as to physical fitness. Inoculation against 
enteric fever, which is now compulsory for all nurses 
coming out, is done free of charge at the pathological 
laboratory of the Royal Medical College at Mill- 
bank, and the association is much indebted to the 
Director- General of the Army Medical Service for 
this privilege. 

Association nurses are also permitted by the London 
School of Tropical Medicine to attend the lectures de- 
livered by Sir Patrick Manson and Dr. Sandwith. These 
lectures include both the nursing of tropical diseases 
and the preservation of health in the tropics and are of 
very considerable importance to nurses going to India 
for the first time. 

In order to meet the criticism that nurses must of 
necessity become old-fashioned in their methods after 
five years' private nursing, it was agreed that, if desirous 
to re-engage, they must consent to go through a course 
of three months' training in some recognised hospital 
approved by the central committee either at home or in 
India, and, at the termination of such period, must 
produce a certificate of efficiency. 

There is also an association of Indian ladies who 
are undertaking to do something in nursing education, 
as shown by the following editorial from the Nursing 
Journal: 

The Seva Sadan, or Sisters of India Society, has just 
closed its second year. It is an association of Indian 
ladies who are trying to build up a sisterhood of women, 
who, irrespective of caste or creed, shall devote themselves 
to philanthropic work, much as Christian deaconesses do 
in other lands. . . . 

The Sadan has eight probationers in Bombay under a 



India 253 

Matron who gives her services free. One of these pro- 
bationers is taking a nurse's training in the Sir Jamsetjee 
Jejeebhoy Hospital. She is maintained by the Sadan 
and will give her services to it, but the Sadan 's officers 
desire to get a place where they can provide accommoda- 
tion for in-patients and have at least one resident lady 
doctor and train their own nurses. 

One of the friends of the association collects Rs. ioo 
a month to secure a nurse and midwife for work among 
the poor. Two nurses are employed, who visit the sick 
in all parts of the city and its suburbs. . . . 

What chiefly interests us is the nursing part of their 
work. We could wish that the Sadan would send all 
its nurses to training schools in connection with large 
Indian hospitals, thus ensuring a good general preparation 
for their work, instead of opening a small hospital for 
training them itself. The report reads: "We want the 
public to realise that, to bring together women who have 
the same ideal of service, and to place them amidst sur- 
roundings, where, practically, nothing but service (seva) 
occupies their minds, is to solve half the problem of de- 
veloping a true missionary spirit. We are at present 
making the best use of existing agencies. But there is 
a difference between institutions teaching paying occu- 
pations and turning out workers for pay, and institutions 
which aim at giving to the country devoted women, 
wedded to the ideal of loving, self-sacrificing service, and 
bearing ' the torch of knowledge and the balm of physical 
and spiritual comfort all over this ancient land, through 
the all-embracing agency of sisterly love and good- will. ' " 
We do not think the report is quite fair here. These 
high motives of service are always kept in the foreground 
in training schools at home, and they are found very 
markedly in the superintendents of nurses out here. 
They form the ideal which is set before all the Indian 
girls who take up a training, even though they may have 



254 A History of Nursing 

to make nursing their means of livelihood, and if the 
Sadan can send among them girls who already have 
these high aims, there must be gain on both sides. ■ 

The outline here given may, it is hoped, bring an 
impression of nursing in India before the mind, but 
by no means does it indicate its extent. The lists 
of membership in the national society show fifty or 
more hospitals, many built and supported by the 
government, others expressing the munificence of 
wealthy Hindus or Parsees, as well as the mission 
hospitals. The women holding executive posts in 
these institutions are as yet preponderatingly English 
or American ; one Indian nurse's name appears in the 
column of 1910, that of Rosie Singh, trained in the 
Memorial Hospital at Ludhiana and holding a post 
in the Sarah Seaward Mission Hospital at Allahabad. 
But in the future, Indian nurses should and doubtless 
will come into membership in ever larger numbers. 
At the Trained Nurses Association meeting in 1910, 
the question was discussed whether or not there 
should be a separate branch for the Indian women. 
Miss S. M. Tippetts (Guy's Hospital), Miss Tindall 
(Metropolitan and City of London), Miss Steen 
(Royal Infirmary, Edinburgh), Mrs. Klosz (Johns 
Hopkins), and others in the forefront of Indian nurs- 
ing affairs took the just and right position that true 
professional unity must be their aim, and the Indian 
nurses be encouraged to develop into organisation 
work, not by themselves, but all together. At the 
same time, the superintendents' papers and discus- 
sions dwelt upon the enormous difficulties surrounding 

1 Nursing Journal of India, Oct., 19 10. 



India 255 

the training of native women and the indispensable 
need of their being trained by nurses, not by doctors, 
especially not by men, who could not — did not know 
how to — train. 

The story of nursing progress in India is woven 
through with the influence of Sister Winifred Thorpe, 
whose life of abounding gifts was ended by a dis- 
tressing accident in 1909, and whose buoyant, 
inspiring personality, now gone, is mourned as a per- 
sonal grief by her co-workers. She was trained in 
the Richmond Hospital, Dublin, and looked forward 
even then to mission work in India. Miss Tippetts 
spoke of her to the nurses' association in 1910, in the 
following terms: 

Almost entirely to her splendid zeal and enthusiasm 
were due the formation and organisation of, first, the 
Association of Nursing Superintendents of India and, 
later, of the Trained Nurses Association. 

She worked untiringly as secretary and treasurer of 
these associations, when the work entailed must have 
been a heavy tax in addition to her already heavy hospital 
duties. She inspired all those with whom she came in 
contact, and by organising these two associations, she has 
left her mark on the nursing profession of India. 

Her enthusiasm was unflagging, and her dearest hope 
was to see nursing in India put on a thoroughly satisfact- 
ory basis and brought up as nearly as possible to the 
standard of nursing at home. She believed, as we all 
hope, that the associations will set a very high standard 
of work and character among the nurses of India, and 
that they will^help and support them in the difficulties 
that are well-nigh insurmountable alone. 

We can never forget Miss Thorpe's splendid work, 



256 A History of Nursing 

and her name will ever call forth our admiration and 
gratitude. 

Japan. The recorded history of nursing in Japan 
begins twelve hundred years ago with the legends of 
the empress whose figure corresponds to that of the 
holy Elizabeth and other nursing saints. A transla- 
tion of her story was brought from Japan by Miss 
Wald and Miss Waters of the New York Nurses' 
Settlement, and runs thus: 

Over twelve hundred years ago there lived an empress 
whose name was Komio. She was the wife of the Emperor 
Shyomu, who built many temples, and brought many 
sacred objects from China and India. She was endowed 
with a very merciful and charitable heart. She estab- 
lished two charitable institutions: (1) Hidenin, a place 
where orphans and aged people came to be taken care 
of; (2) Seyaknin, a place where the poor were provided 
with medicines and necessary things for the sick. [A 
charity hospital.] With the permission of the Emperor 
she built a house where people came to be bathed, and 
sent word to the near-by towns that the Empress herself 
would bathe the lepers. The number [to be bathed by 
her own hands] was limited to one thousand. One after 
the other the patients came, but when the number 
reached 999, there was a sudden stop to their coming. 
The Empress was greatly disappointed and wondered 
why there was not one more to make up the number. 
Finally there came a very ragged dirty man, whose whole 
body was covered with ulcers, of which the odour was 
enough to make those sick who were near by. He 
stopped at the gate and asked those inside to let him in. 
But he was so filthy that the custodian refused to let 
him in. The ragged man still begged repeatedly to be 




a 

m 
O 

W 

-1-5 

'C 

6 






Japan 257 

admitted, and finally the word reached the Empress and 
she sent out her orders that he be let in, and they were 
obeyed immediately. 

The leper was led to the bathroom by the Empress 
herself, in reply to his plea that she should bathe him. 
She was so abounding in mercy that she did not hesitate 
a moment, and while she was washing the leper he was 
suddenly transformed into a very perfect being. As- 
tonished, she asked him who he was. Then in a loud 
voice he answered: "I am the image of Ahiniyorai; I 
came to see whether you were doing this work from your 
heart or only to gain the praise of the people." Then he 
rode on the purple cloud and vanished away. So bright 
a light radiated from him as he disappeared that the 
people named the place " Komio San Ashikaji." [Komio 
— light or bright; San — mountain.] 1 

From the day of the merciful Empress we come to 
modern times, convinced that her story is an emblem 
of the ministrations of gentle, delicate Japanese 
women to the sick and suffering, even though they 
were not recorded or performed in public. 

The Charity Hospital in Tokio, one of the best 
charity hospitals in the country, was established in 
1882. The first training school in Japan was that 
started in September, 1885, by Miss Linda Richards, 
who, early in that year, was sent by the American 

1 Hospitals and asylums for lepers in modern times, we are told, 
have been chiefly founded and carried on by foreign missionaries: 
by a Catholic Father at Hakone; by Miss Youngman, an American 
missionary, in 1894, at Tokio; by Miss Riddell and Miss Knott, two 
English missionaries, at Kumamoto, in 1895, and others. See page 
108, vol. ii., of Fifty Years of New Japan, in two volumes, compiled 
by Count Shigenobu Okuma, English version edited by Marcus B. 
Huish; London, Smith, Elder & Co., 1909. The story of the Empress 
was written down for Miss Wald by a Japanese friend. 

VOJ- IV. — ** 



258 A History of Nursing 

Board of Missions to organise a school for the training 
of women nurses in the Doshisha Hospital in Kyoto. 
Beginning with the tiniest outfit and accommoda- 
tions, but with a group of well-educated girls and 
married women, the school graduated its first four 
pupils in June, 1888, and its reputation had so grown 
in the meantime that the second year opened with 
thirty patients, new wards, and a home for nurses. 
Miss Richards stayed for five years in Japan, and 
after her departure the school came under Japanese 
management. 1 Her first printed mention of this 
work was made in 1902, when she wrote: 

So it came to pass that the first training school for 
nurses in Japan was organised and, for a time, controlled 
by Americans. At first, like all new movements, it was 
carefully watched to see if it was really just what was 
wanted to meet the demands . . . There are no people 
more quick to recognise merit in any enterprise than the 
Japanese, nor can a people be found who will more quickly 
detect weak points. Notes of merit and demerit were 
carefully made, and soon it was pronounced a good and 
desirable thing. . . . Shortly a second and much more 
important school was opened, having for its patroness the 
Empress herself. It was organised in connection with 
the Empress's Hospital, and, of course, received the 
sanction and support of the government. . . . The 
Japanese did not consider all methods in use in foreign 
training schools perfect, and decided to improve upon 
them. If training schools were to benefit women, it 
was thought they should be educational institutions, 
and pupils in them should have similar advantages to 

1 Reminiscences of America's First Trained Nurse, by Linda 
Richards, Whitcomb & Barrows, Boston, 1911. 



Japan 259 

those in other schools ; they must be treated as scholars, 
and, therefore, an entrance examination was required. 
The nurses were to be self-supporting, the hours of duty- 
must be fixed, and those for study, lectures, and recita- 
tion must be ample. Most of the applicants were gradu- 
ates from good schools, young women of high purpose, 
with a determination to succeed, and to such success is 
assured. x 

Miss Richards's work laid the foundations for a 
friendly feeling between American and Japanese 
nurses. Since that day many Japanese probationers 
have come to America for training, and others, 
trained at home, have come for post-graduate work. 

A vivid description of the organisation and ideals 
of modern Japanese nursing was brought by Miss 
Hagiwara to the London Congress in 1909, and is here 
repeated almost in full. It was prepared in the Red 
Cross headquarters in Tokio under the direct aus- 
pices of Prince M. Matsukata, president of the Red 
Cross Society of Japan, to whose kindness and interest 
in the International Congress of Nurses we owed the 
friendly participation of Japan and the presence of 
several Japanese nurses, one of whom came from Paris 
as a delegate from her country. The war between 
Japan and Russia had brought the brilliant achieve- 
ments of Japanese nurses into world-wide renown, 
attracting the interest and sympathy of those in all 
other countries. When, therefore, these little ladies 
came upon the platform beautifully dressed and cov- 
ered with decorations for valour in three wars, the 
stir and interest were lively and cordial. They 
quickly won all hearts, and Miss Hagiwara, the 

1 American Journal of Nursing, April, 1902, p. 491. 



260 A History of Nursing 

delegate, was one of the centres of attraction at the 
reunions. 

The work of nursing in Japan has no such old history 
as in Christian countries. The association of Christian 
Sisters is unknown in Japan, not because there was no 
charity in the country, but because Buddhism — Japan's 
chief religion for centuries — laid much greater stress upon 
helping the poor than upon nursing the sick and wounded. 
In addition to this fact, up to very recent years, social 
rules as to the separation between the sexes were so strict 
that, outside the sphere of family relationship, no idea 
could be entertained of a woman taking care of a sick or 
wounded man, unless for pay, and mercenary nursing 
has not the same element of charity and self-sacrifice in it. 

The art of nursing by women was first introduced with 
the art of treating patients according to Western methods, 
and nurses are now being employed in great numbers in 
all the hospitals, public and private; and considering that 
there are in the whole of Japan 102 institutions for their 
training, besides those belonging to the Red Cross Society, 
we may presume that their number is very rapidly in- 
creasing. In this paper we shall not attempt to describe 
other institutions than those of the Red Cross Society. 
Several local governments have within recent years en- 
forced regulations according to which only those qualified 
for the work can make nursing a profession. But our 
present purpose is to introduce to our Western sisters 
the Red Cross nurses of Japan. 

The 14,000 nurses of our Red Cross Society are in two 
divisions, namely, voluntary nurses and relief nurses, 
whose duties have been developed upon the following 
lines. 

The Japanese Red Cross Society collects contributions 
from generous and patriotic people, and, with the capital 
so realised, trains and exercises the relief personnel of 



Japan 261 

both sexes in time of peace, in order to assist the medical 
service of the army and the navy in time of war. And in 
order that the Red Cross Society may properly execute 
its plans, it is necessary that everybody belonging to its 
relief personnel should do his or her work, not for the sake 
of personal gain, but with the idea of moral duty, an 
idea which can be sought for only among the higher 
classes of society. But, under the old regime, the women 
of the higher classes were exactly those that were bound 
most strictly by the rules concerning the separation of the 
sexes, and it was almost hopeless to induce them to be- 
come nurses whose part it was to take care of the sick 
and wounded soldiers that were not their relatives, not 
even friends. To overcome this difficulty a special plan 
was adopted, and executed with lasting success, by the 
founders of the Japanese Red Cross Society. It consisted 
in inducing ladies in the highest class of our society to 
show by personal example that nursing is a noble and 
honourable work — noble enough even for the daughters 
of kings and princes — if done, not for gain, but with the 
elevated idea of a moral duty. Let all praise be due to 
our most benevolent and loving Empress that she con- 
curred in this plan, and caused the princesses of the Im- 
perial family and the wives and daughters of the highest 
dignitaries to take part in its execution. 

Thus, in May, 1887, the year in which the Japanese Red 
Cross Society joined the international association of her 
sister societies, an association of about twenty ladies was 
formed, with Princess Arisugawa for its president, and all 
the other princesses of the Imperial family for its vice- 
presidents. They came together once in every month to 
receive instruction in nursing and dressing wounds, 
and more ladies were invited to join the patriotic work. 
This attracted such public attention that in a short time 
its members increased a hundredfold, and had not only 
the effect of dispersing all the idea of meanness connected 



262 A History of Nursing 

with nursing, but also that of breaking through the 
custom of our ladies leading a life of seclusion and retire- 
ment, and gave them the impulse to come out and take 
part in the work of public utility. This is the origin of 
the Volunteer Nursing Association in Japan. Its sub- 
sequent development was remarkably rapid, and it 
rendered great services in the Chinese war of 1894, the 
Russian war of 1904, and the Boxer troubles of 1900. 
It now forms an important auxiliary force, side by side 
with the relief nurses to be next described. It has its 
central committee in the headquarters of the Japanese 
Red Cross Society in Tokio, and forty-four branches in 
the different provinces of the Empire, and counts at 
present over ten thousand two hundred members. Not 
a few of the foreign residents in Japan take part in it, 
and it is our great pride to count among its associates 
Lady Macdonald, wife of the British Ambassador, and 
Mrs. Richardson, now in London, widow of the late 
Colonel Richardson, who had fought for his country in 
South Africa. 

Let us now pass on to the relief nurses of our society. 
The name demands an explanation. All the persons that 
the Japanese Red Cross Society specially trains in view 
of service in time of war, according to the regulations 
authorised by the army and navy, constitute the relief 
personnel, and the nurses that form a part of this per- 
sonnel are relief nurses (the volunteer nurses just de- 
scribed form no part of relief nurses, because they are not 
included in the relief personnel). The relief nurses are 
taken from among general candidates upon examination, 
and are subjected to special training, at the expense of 
the society, either in its main hospital in Tokio or in the 
hospitals belonging to its local sections, for the term of 
three years, during which they are called the "proba- 
tioners ' ' of the Japanese Red Cross Society. In provinces 
where no Red Cross hospitals exist, arrangement is made 



Japan 263 

with other public or private hospitals for their training 
in the way fixed by the society. They are also from time 
to time sent to military and naval hospitals in order to 
be instructed in matters connected with the medical or- 
ganisation of the army and navy. The " probationers " 
are between sixteen and thirty years of age, and un- 
married. We have not yet been able to make inquiries 
as to the position of women that volunteer to become Red 
Cross nurses, but we are almost sure that the difficulty 
of marriage is not the cause; for dowry, which makes 
marriage such a difficult thing in Europe, is almost un- 
known in Japan. As already said, the strongest motive 
would be that of following the example set by the ladies 
in the highest position devoting themselves to nursing 
out of patriotic ideas; to which we might perhaps add 
the motive of acquiring some art which can serve as a 
means of leading an independent life, whenever compelled 
by circumstances to do so. At all events, all the proba- 
tioners belong to the middle and higher classes of society, 
for only those with an adequate amount of education are 
admitted. After graduation they are bound by a solemn 
oath, written in documents, to remain faithful to the 
principles and respond to the calls for service of the 
society any time during the period of fifteen years, reck- 
oned from the date of graduation. Travelling expenses 
and salaries are paid to them whenever called on by the 
society and during the time of their service. 

The three years' course is divided into the first term 
of one year and the second term of two years, the former 
being devoted to theoretical instruction and the latter 
to practical training. The theoretical instruction con- 
sists of the outlines of anatomy and physiology, bandag- 
ing, nursing, disinfection, obstetrics, diseases of women, 
nursing of the first born, assisting surgical operations 
and medical treatment, massage, manipulation of instru- 
ments, improvised treatment of the wounded, hygiene, 



264 A History of Nursing 

outlines of pharmacology, and transport of patients. 
Also, the "Instructions to relief personnel," ethics and 
11 Moral counsel to nurses," " Rules of saluting and other 
etiquette of the relief corps," grades and denominations 
of military and naval officers and their uniforms, inter- 
national treaties concerning the Red Cross work, a sketch 
of the history and organisation of the Japanese Red Cross 
Society, and the organisation of its relief work in time of 
war, are taught as side studies. Lessons are also given 
in the treatment and feeding of patients in military 
hospitals at the front, the disposal of deceased patients 
and of their wills, the service in the base hospitals and 
the fortress hospitals of the army and in the hospitals of 
the navy. Foreign language is optional. A glance at 
the subjects taught will show that it is only the well- 
educated daughters of the middle and the higher classes, 
possessed of intelligence above mediocrity, that can aspire 
to become relief nurses of our society. 

Those that have shown themselves to be excellent both 
in theoretical training and practical work are subjected 
to a course of special training for another six months in 
the Red Cross Hospital of Tokio, after which they are 
once more examined, and, if successful, are granted the 
diplomas qualifying them to be head nurses of the society. 

During training the probationers are obliged to live 
in the dormitories under the strict guidance and control 
of their superiors. They are not permitted to discontinue 
the study at their own will, unless it be on account of 
illness or other disqualifying circumstances. 

Since this system of training was begun in 1890, 4067 
students were admitted, of which 3160 graduated, 486 
died or had to give up the study before graduation, and 
421 are still under training. The relief nurses of the 
society are free to marry or to adopt any mode of life 
thev choose, provided they remain faithful to the vow 
and keep themselves ready to respond to the calls of the 



Japan 265 

society at any moment ; but, of course, a great majority 
of them willingly continue their work in public and priv- 
ate hospitals, or offer their services to private families, 
where they are especially welcomed, and enjoy very good 
reputation on account of their education and good dis- 
cipline. For fear lest among such a great number there 
may be some one or other that goes astray and does things 
detrimental to the dignity of a Red Cross nurse, a home 
for the graduated nurses is established in the Red Cross 
Hospital in Tokio, under the name of "Department for 
Services Outside the Hospital," and those that wish to 
employ Red Cross nurses are made to apply and pay to 
this department, which looks after the wants of the in- 
mates and deducts a small portion of the fees received to 
defray the expenses of their protection and control. 
This arrangement also serves as a means for rapidly des- 
patching the nurses in cases of public calamity. 

Service in Time of Peace and of War. 

The voluntary nurses have no fixed obligations in time 
of peace beyond receiving instruction at the regular 
meetings of the association and volunteering for relief 
work or visiting patients when there is a sudden necessity, 
in consequence of earthquakes, inundations, great fires, 
and the like. In time of war they devote themselves to 
works either resolved upon by the association or commis- 
sioned by the military or naval authorities. In the 
Chino- Japanese war of 1894, f° r instance, a great number 
of them, including the princesses of the Imperial family, 
assembled day after day in the hospital of the society 
to make bandage-rolls in great quantities, partly as free 
gifts to the army, but mostly in compliance with the de- 
mand made to the association by the Army Medical Ser- 
vice. Also, two of the oldest members of the association 
repaired to Hiroshima, which was the base of operation 



266 A History of Nursing 

of the army fighting in China, and became directresses 
of the relief nurses serving in the military hospital of 
that place. Other members, all of them ladies in the 
highest position, visited the military and naval hospitals 
as representing the whole association. These visits to 
hospitals are regarded as a matter of great importance in 
Japan, for among the soldiers are men from the lowest 
classes, such as labourers and coolies, who can never hope 
to converse with ladies of the highest position in ordinary 
times ; but when they are admitted into hospitals as sick 
or wounded soldiers they are spoken to and consoled by 
these ladies, and the feeling of honour done to them 
certainly does them good. 

In the Boxer troubles of 1900 the sick and wounded 
were not numerous; but the ladies of the Voluntary 
Nursing Association paid visits to patients, and also 
tried in many ways to encourage the relief nurses working 
in the hospitals and hospital ships. 

But it is in the late Russian war that the Voluntary 
Nursing Association, hitherto playing rather a decorative 
part in the whole organisation of the Red Cross work in 
Japan, showed a great activity and proved itself to be 
an important factor in the real relieving force of the 
society. In the seventeen provinces of the Empire, the 
real work of nursing in the base hospitals of the army 
and in their sections was actively assisted by the members 
of the association living in the respective localities, and 
in every landing-place and railway-station where the sick 
and wounded soldiers returning from the front were made 
to rest and take meals, rest-stations were established by 
the local committees of the Red Cross Society and worked 
by the members of the Voluntary Nursing Association, 
some changing the bandages or washing the faces of the 
soldiers, and others aiding them in taking meals. Others, 
again, paid visits to hospitals, distributed presents to 
patients, and even occasionally gave entertainments in 



Japan 



267 



music and other amusements in order to make them 
forget their sufferings. 

Some of the members in Tokio devoted themselves 
to the manufacture of bandage-rolls and caps for 
patients; and her Majesty, the Empress, visited their 
workroom to encourage the ladies, and contributed 
to the fund of the undertaking. One thing to be es- 
pecially noted is that all through this long war every 
single packet of bandages carried by Japanese soldiers 
in their pockets was manufactured by our voluntary 
nurses. These being the very first bandages that are to 
be placed by the soldiers themselves on their fresh wounds, 
the medical authorities of the army wished to be abso- 
lutely sure that they were properly disinfected and rolled, 
so that their manufacture could not very well be trusted 
to merchants. That is the reason why they asked the 
Voluntary Nursing Association to undertake the task. 
Two hundred and fifty members, including the Imperial 
princesses, took part in the work and laboured hard 
from nine in the morning till four in the afternoon, 
through heat and cold, between the months of June, 1904, 
and of February, 1905. Such a fact as this could not 
fail to act as a great stimulus to the relief nurses render- 
ing their services in other districts, and contributed not 
a little to the encouragement of soldiers going out to 
expose their life and limbs to enemies' fire and swords. 
Again, all the sick and wounded soldiers brought home 
from the front and transported to provinces east of Tokio 
had to pass through that city, and every time announce- 
ment was made of trains carrying such patients arriving 
there, the Imperial princesses, with other members of the 
association in their suite, repaired in turn to the railway- 
station, personally consoled the soldiers, and distributed 
to them patients' caps made by themselves and the ladies 
of the Court. In this war, 281 1 members of the Volun- 
tary Nursing Association assisted the real work of relief 



268 A History of Nursing 

in the different localities, 79 of them were decorated for 
their services by the state, and 1399 received diplomas 
of honour from the society. 

The relief nurses especially trained by the society have 
many duties, both in time of war and of peace. When- 
ever a great public calamity takes place, and many cases 
of wounded occur at once, the local section of the Japanese 
Red Cross Society concerned calls together the relief 
nurses under its jurisdiction and despatches them to the 
scene of disaster. Again, when the Imperial army has 
its manoeuvres, all the relief personnel of our society, and 
with it the relief nurses, are also called out for purposes 
of manoeuvring in combination with the troops. Besides 
these extraordinary calls, there is a roll-call once in every 
two years in order to ascertain that the nurses whose 
names are on the list are ready and fit for service in cases 
of national emergency. The occasion is also utilised 
for giving necessary instructions to the nurses. All the 
head nurses are called once during the fifteen years of 
their engagement specially for the purpose of training 
them in the work for which they are intended. The 
writ of calls ought to be served to the persons addressed 
at least twenty days before the date fixed as that of their 
departure. Every time the relief nurses are called, be 
it for roll-call, for manoeuvres, etc., they are subjected 
to physical examination, and if found unfit for service 
in time of war, their names are struck out from the list. 
Should the nurses be behind time in responding to the 
call, or not respond at all, they are guilty of a breach 
of vow, and treated as such, unless a certificate of ill- 
ness, signed by a physician, or a document establishing 
inevitability of the delay, is produced. 

Before September 30th of each year, the president of the 
Japanese Red Cross Society has to draw up a report on 
the preparation of the society for service in time of war, 
covering the period of twelve months after April 1st of 



Japan 269 

the following year, and present it to the Ministers of War 
and of the Navy, who utilise the personnel of the society 
in their plan of preparation for the emergency of war. 
Should war actually break out— which may God forbid ! 
— and orders are issued by the ministers to organise the 
relief corps of the society in accordance with the plan 
of preparation, the nurses required for the relief corps 
mobilised are called, and every time a vacancy occurs 
after the corps have once been formed, supplementary 
calls are made. These two cases of call are to be carried 
out with the greatest strictness. In each local section of 
the society, forms of call-order are printed and stored 
away in time of peace, ready to be filled in with the nec- 
essary items before sending out, and, when sent out, the 
nurses addressed to, or the persons responsible for, the 
management of affairs during their absence are bound to 
post the receipt within twelve hours from the moment 
the order has reached them. In fact, everything is just 
like the calling in of reserve forces of the army. 

The nurses thus called are incorporated into relief de- 
tachments and personnel of the hospital ships. These 
are the two hospital ships owned and equipped by the 
society, to be distinguished from the many ordinary 
merchantmen temporarily used as hospital ships by the 
army. The relief detachments, so-called, are the units 
of the relief organisation of the society, usually composed 
of two medical officers, one pharmaceutist, one clerk, two 
head nurses, and twenty nurses. In some detachments, 
attendants (men) are used instead of nurses. These 
units the military and naval authorities are at liberty to 
subdivide into smaller units, or combine to make greater 
ones, and employ them in hospitals and hospital ships. 
Usually the units formed of men attendants are sent to 
the front; while those composed of nurses are employed 
on board the hospital ships and in the hospitals at the 
base. Neither the army nor the navy has nurses, and 



270 A History of Nursing 

for this indispensable element of good medical and surgi- 
cal treatment, both depend entirely upon our society. 
And the way in which our relief personnel is employed 
as part of the medical organisation of the army or the 
navy is special: they are never permitted to work inde- 
pendently, but are placed under the direction and control 
of medical officers of the army and the navy, and in many 
cases our personnel work with the government personnel 
in one and the same ward. In each hospital ship there 
are only one directing medical officer and one or two non- 
commissioned officers representing the army, and all the 
rest of the medical staff is composed entirely of our relief 
personnel. 

Of the 152 relief corps the Japanese Red Cross Society 
organised and used in the Russian war, 102 were relief 
detachments formed of nurses, 14 those composed partly 
of nurses and partly of men attendants, besides the 
personnel for the two hospital ships of the society, 
composed likewise of nurses and attendants. The de- 
tachments were used by the army and the navy in the 
following way: 77 detachments in twelve base hospitals 
and one fortress hospital of the army, 4 detachments in 
two hospitals of the navy, 35 detachments in twenty 
hospital ships of the army. The number of nurses 
employed was: 1 directress of nurses, 255 head nurses, 
2526 nurses — total, 2782. 

As the nurses belonging to the society were insufficient 
after the battle of Liao-yang, 829 out of the above number 
were recruited as a temporary measure from among the 
nurses trained at the Tokio Charity Hospital, the Medical 
College of Okayama, the Kumamoto branch of the 
Japanese Sanitary Association, etc. ' We have also to 
count the 99 relief nurses attached to the 20 rest-stations 
at landing-places and railway-stations. 

The total number of the sick and wounded soldiers 
cared for by the eighty-one detachments serving in the 



Japan 271 

base hospitals of the army and the hospitals of the navy 
was: 217,488 Japanese; 6743 Russian — total, 224,231. 

Our detachments in the base hospitals were usually 
entrusted with the treatment of the gravest cases and 
infectious or contagious diseases, and where separate 
wards were established for the sick and wounded Russian 
soldiers, the Red Cross medical officers and nurses were 
placed in charge of such wards, as a rule. A special 
hospital having been established at Matsuyama for the 
wounded Russian sailors, victims of the battle of Nin- 
Sen (Chemulpo), the Minister of the Navy entrusted its 
entire management to our medical officers and nurses, 
who worked independently. 

The work of the nurses in the two hospital ships of 
the society and the twenty hospital ships of the army 
during many consecutive months was the hardest for 
women, for that part of the sea is rough for the greater 
part of the year. 

In this war, 39 nurses out of the total above given 
died, 409 had to be released from work on account of 
illness and other causes, and 2725 were rewarded by 
the state either with Orders or with money, or both. 

Conclusion. 

The above resume will have shown the actual state of 
nurses and nursing in Japan as far as the Red Cross 
Society is concerned. 

In conclusion, let me say a few words with regard to 
the special trait of our relief nurses, on whom the society 
relies most for its work in time of war. If there be any 
point in which they differ from the nurses in other coun- 
tries, that difference must come from the fact that they 
are trained with the sole object of assisting the medical 
service of the army and the navy. It is true that they 
are employed for relief work in the case of public calami- 



272 A History of Nursing 

ties as well, but only so far as there is surplus force, and 
then only as a means of exercising the relief work in time 
of war. At that time they are incorporated with the 
medical organisation of the army and the navy, as al- 
ready said. To our knowledge, there is no country 
except Japan where only relief nurses — that is, thoroughly 
trained nurses bound by oath to serve the society — are 
relied upon by the Red Cross Society in preparing for work 
in time of war. l Voluntary nurses are used only as an 
auxiliary force, because it has been found difficult to 
keep up the rigid rules with volunteers, rules which serv- 
ice in the army and navy requires. Nobody is obliged 
to become a relief nurse of the Japanese Red Cross 
Society, but if once admitted and trained as such, the 
relief nurses are bound by oath to conform themselves to 
all the conditions of service, however strict, which the 
society imposes upon them, and that with military 
exactness. From this arises the distinguishing charac- 
teristic of our nurses, which may be summed up in the 
one word — discipline. 

They pay attention to the minutest rules of correct- 
ness connected with their uniforms, postures, ways of 
saluting their superiors and of conversing with their 
equals; they are scrupulously clean and tidy, but never 
coquettish. They are always taught "to respect the 
patients, but not to become familiar with them," so that 
they never converse in a low voice with patients or cor- 
respond with them in writing. They do not accept 
presents in any form from the patients or their relatives, 
unless it be through the medium of the society. It is 
this fact of their being absolutely well disciplined and 
correct that made Japanese military and naval authorities 
decide to use the Red Cross nurses in the hospitals of the 

1 This will hereafter be true of the United States also. All other 
Red Cross societies accept untrained volunteers. — Ed. 



Japan 273 

army and the navy, and the society is making every 
effort to make this precious quality as pronounced as 
possible. But, it may be asked, how is this quality 
maintained? It is clear that it can only be kept by 
constantly holding up a high ideal, strong enough to 
counteract all baser inducements, and this ideal is love 
of country, which with us is the ideal that burns most 
bright in the heart of every man and woman 

It is a patriotic thing to nurse the sick and wounded 
soldiers, and women can nurse much better than men. 
Here, then, is the natural way in which women can be 
patriotic and do something for their country. Such is 
the thought which makes our nurses endure the hardships 
of a long training and respond with willing heart to the 
first call in time of war. "The Moral Counsel to the 
Red Cross Nurses" contains only twenty paragraphs, 
of which the following two will clearly show the intent 
of the whole: 

"III. — Do not avoid danger or dislike dirt and filth 
if it be for the sake of your patients : and even if they be 
haughty and rude, never enter into direct dispute with 
them, remembering that to nurse the sick and the 
wounded is a duty towards the state which patriotism 
imposes upon you." 

"XX. — The soldiers in time of war separate themselves 
from their parents, wives, and children, and undergo 
hardships and privations in order to sacrifice themselves 
loyally and faithfully to the cause of the Emperor. 
They are the iron fortresses of the realm. The role of 
Red Cross nurses being to nurse and alleviate the suffer- 
ings of these soldiers when sick or wounded, they serve 
the state indirectly by giving relief to the patients 
directly; and should they perform this work well with 
benevolence (towards the patients) and loyalty (to the 
state), we may say that they are as meritorious as the 
soldiers themselves running about in the battlefields 

VOL. IV. — 18 



274 A History of Nursing 

under the shower of shells and bullets. It is a matter 
of great honour for a woman to be able to take part in 
service in time of war, and only those that follow in 
ordinary times the counsel as set forth in the above 
paragraphs shall be able to keep this honour intact. 
Hence it is that, over and above the technical studies, 
a behaviour in good conformity with the moral ideal is 
necessary." 1 

While this paper relates only to Red Cross nurses, 
who set the pattern for the country, there are many 
large city, county, and private hospitals in Japan that 
train excellent nurses for work in civil life. Their 
courses are from two to three years. 

The first bold innovation in army nursing was 
carried through b}^ Surgeon- General Tadanori Ishi- 
guro, who was in charge of field sanitation during 
the war with China. He decided to call nurses to 
the Reserve hospitals, and says of this campaign : 

For the first time in Japanese history, by utilising the 
services of the Red Cross medical staff, female nurses 
were employed in the Reserve hospitals, these nurses 
having been trained for years at the Red Cross Hospital 
in Tokio, under the supervision of Dr. Hashimoto. This 
employment of female nurses met with loud opposition 
from some quarters because of antiquated notions re- 
garding the relative status of men and women in Japan, 
but I stoutly maintained my original position and em- 
ployed the Red Cross Hospital nurses in the military 
hospitals of Hiroshima and elsewhere. The results 
amply justified my course of action, for all these nurses 
proved an unqualified success. 2 

1 Reports, Int. Cong, of Nurses, London 1909. 

2 Fifty Years of New Japan, vol. ii., p. 317. 



Japan 275 

In May, 19 10, the Red Cross Bulletin of Japan 
said of Miss Hagiwara and the London Congress : 

The Red Cross Society of Japan was requested by the 
International Council of Nurses to represent itself at 
the Second Quinquennial Meeting of the International 
Council of Nurses, convening in London from July 19 
to July 23, 1909, to discuss the methods of nursing and 
its development. In response to this, the society des- 
patched as delegate Miss Take Hagiwara, chief nurse of 
the Red Cross Nurses' Union, and made her report on 
"Nursing under the Red Cross Society of Japan." She 
served as nurse in the three late military campaigns 
abroad, that is, the Chino-Japanese war, the Boxer re- 
bellion, and the Russo-Japanese war, and is at present 
engaged in the Central Hospital as assistant inspector 
of nurses and student-nurses ; so her experience in nursing 
may be said to be very rich. She returned from her 
commission successfully fulfilled on September 29th. The 
International Council of Nurses asked the society to 
elect her as vice-president of the Council, to which we 
cheerfully consented. 

All the world knows how brilliantly Japan distin- 
guished herself in nursing, preventive medicine, and 
sanitation, as well as by bravery on the field, in the war 
with her terrible neighbour, Russia. Dr. Louis Seaman 
declared that Japan's greatest triumphs had been in 
the humanities of war, * and instanced the fact that 
she had reduced the usual mortality from preventable 
causes over eighty per cent. The wonderful capacit}' 
of the Japanese nurses made it unnecessary for the 
nation to apply for nursing help elsewhere, and the 

*Red Cross Bulletin, No. 2, 1908, p. 73. 



276 A History of Nursing 

nursing relief party that was called together and 
offered to the government by Dr. Anita Newcomb 
McGee may easily have been rather more of an em- 
barrassment than help to the heavily burdened 
nation. The report of the Japanese Red Cross So- 
ciety on the Russo-Japanese war, presented to the 
Eighth International Congress of Red Cross Socie- 
ties gives a most tactful account of this expedition, 
saying : 

Mrs. Anita Newcomb McGee, M.D., of Washington, 
having made an offer to our government to come to Japan 
with 600 female nurses and assist in the relief of the sick 
and wounded soldiers, our government consulted the 
Red Cross Society about the matter, and decided to 
accept her offer provided she would agree to come with 
only a few nurses. 

Although in the progress of this party there was 
something that seemed more congruous with tri- 
umphal processions than with the unassuming work 
of nursing, yet there were excellent nurses and ad- 
mirable women in its rank and file, and, animated by 
a sincere desire to be helpful, they did some good work, 
and friendships were formed that have had a distinct 
part in bringing the nurses of the two countries closer 
together. 

Perhaps the Japanese nurse who knows America 
best is Miss Choko Suwo. After the war, she came 
here with friends and took several post-graduate 
courses, one at the Woman's Hospital in New York 
under Miss Gladwin (who had been with the expedi- 
tion to Japan, and who was conspicuously successful 
in making the course valuable, thus attracting ex- 




ij fl o 

"So oJ S 

^ .S c 

r^ 3 ^ .2 

H c -5 




China 277 

ceptional women from all over the world), and after- 
wards at the Nurses' Settlement on Henry Street. 

Miss Suwo intended to organise visiting nursing 
and perhaps settlement work on her return to Japan, 
though realising well the difficulties in introducing 
such innovations. After her first year's effort she 
wrote : 

It is very hard to help very, very poor people in such 
a way. They cannot understand the meaning of it, so 
they do not trust themselves to me. We must teach 
the mothers first. They are understanding more day 
by day, so I can do better in the near future. I under- 
stood that everything is very hard in the beginning. I 
need a great deal of patience in the work. I hope this 
year will bring success to this good work. 

Miss Nightingale is greatly revered in Japan. 
Nurses are taught her life, and Red Cross Sisters 
held a solemn memorial service when she died. 

China. In China, as in India, the missions cut the 
first path in hospital work, and the first trained nurses 
in China were brought there under the auspices of mis- 
sionaries. The earliest reminiscences we have found 
are those of Sister Ethel Halley, an Australian nurse 
who, writing in Una in October, 1910, described her 
experiences when, in 1890 or '91, she went, full of 
hope and energy, to her life-work in the Shantung 
Road Hospital in Shanghai. Nursing, she said, was 
unknown, and she spent fifteen years at work in 
China before she had any nurses. The training of 
young Chinese women is, therefore, of recent date. 
Sister Ethel Halley's recollections, besides including 



278 A History of Nursing 

many humourous aspects of hospital life, ran to the 
social conditions of her patients as well — to the cruel 
exploitation of little five-year-old children as factory 
hands at night work, and to the bitter lives of the 
little slave girls who, painted and dressed, had to 
earn their living as prostitutes. 

St. Luke's Hospital, at Shanghai, which celebrated 
its fortieth year of service in 1906, was one of the 
first to train pupils. The London Mission, Peking, 
had a class studying nursing and dispensing under a 
woman physician, Dr. Saville, about 1895, and, in 
1905, this work grew into a training school for nurses 
by the co-operation of the Presbyterian and Methodist 
missions with Dr. Saville for this special purpose. 
The school is now growing and prospering. The 
training covers three years. 

One of the most attractive and interesting of mis- 
sion hospitals is the Margaret Williamson, in Shang- 
hai, under the management of the Women's Union 
Missionary Society. It was opened in 1886. 

The Elizabeth Bunn Memorial Hospital at Wu- 
chang owed much of its enlarged service to the en- 
terprising spirit of Dr. Glanton (a woman), and a 
nurse, Miss Susan B. Higgins, a graduate of Blockley, 
Philadelphia, who quietly made up their minds to 
move into a distant part of the city and work up a 
dispensary service. They had a house selected and 
everything arranged before making their intentions 
known. Others were fearful for their safety; even 
the bishop was afraid for them, but they went, and 
the success of their venture was immediate and per- 
manent. They built up a large dispensary practice, 
brought in many bed patients to the hospital, and 



China 279 

now a training school has grown up. Looking for- 
ward to this, Miss Emma H. Higgins wrote in 1907, 
with hopeful anticipation: 

Two years have been spent in studying Chinese, pre- 
paring to teach the pupil nurses in their own language. 
Our school will not be open before Christmas. . . . 
The Wesleyan Mission has a very good training school 
and their experience has been most encouraging. Their 
nurses are much liked by the doctors and foreigners for 
whom they nurse; they are gentle, capable, and exact, 
making very good private nurses. All they need is 
some one to train them thoroughly. The Chinese young 
women are just beginning to appreciate the opening 
which gives them independence ... it is an intensely 
interesting field and a work that will go on long after 
we are dead, along with the schools of Western medicine 
which are opening, ... we want those who can teach 
others to nurse, so that the Chinese nurses will be 
started right, ready for the time when they decide to 
depend on themselves instead of on the foreigner. x 

In 1908, a Chinese nurse, trained at the Wesleyan 
Hospital, came as assistant superintendent to the 
Elizabeth Bunn Memorial. She was very efficient, 
and capable of teaching the practical work. In 
1909, another graduate, Miss Chiang, was made head 
nurse. Miss Higgins considers that her pupils make 
good nurses; they are, she says, gentle, quick, quiet, 
and observant, and not afraid of work. 

In Canton, in the David Gregg Hospital for 
Women there were in 1909 eleven Chinese girls in 
training, while four had graduated. They were all 

1 Letter from China, A. J. N. t December, 1907. 



280 A History of Nursing 

capable and satisfactory. In this hospital, and per- 
haps in others, a text-book used included the trans- 
lation into Chinese of parts of Isabel Hampton's 
Nursing: Its Principles and Practice. ' 

The Central China Medical Missions Associa- 
tion has pupils under regular training in several 
places. Their grade of education is above the mere 
ability to read and write, and they are beginning to 
understand why the so-called " menial" duties are 
important, and to feel the nurse's pride in her work. 

In 1908, we find Dr. J. C. McCracken, of the 
University of Pennsylvania, in Canton organising 
a hospital. Desiring a nurse to grow up with the 
hospital and develop there a school to train native 
women, Dr. A. H. Woods described the type of nurse 
needed in words that show how far above the average 
must be leaders in foreign countries, if they would 
succeed : 

Just a commonplace nurse would not make a success 
out here at the present juncture. So far as I know, no 
one has yet undertaken in China just the kind of work 
that we desire the nurse to do . . . The woman to do 
this work should be mature, with proper poise, so un- 
questionably a lady that low men-patients would be 
unable to say vulgar things in her presence. She must 
be not only a good nurse, but able to train others, to 
organise the work for us and keept it going. ... If, 
to other qualifications, she could add the virtue of 
widowhood or celibacy, it would leave us with a freer 
outlook. . . . We doctors will keep in close relationship 
with the head of the nursing department. We will all 

1 Chinese Manual of Nursing, compiled by the Central China 
Branch of China Medical Missions Association, Shanghai, 1905. 




Chinese Pupil Nurses 

By Courtesy of the American Journal of Nursing 



China 281 

be together and so should be socially congenial. There 
will be no such thing as friction, if all recognise that as 
specialists each has his own responsibility. The nurse 
has the nurse's special work, which is as dignified as that 
of an architect employed to erect a building. We 
would not look for servile obedience, but we must, of 
course, have the ordinary co-operation such as would 
exist in a good hospital. ■ 

The indescribable need of the Chinese poor, es- 
pecially the women and children, and their winning 
personalities, inspire the mission nurses with the 
fullest devotion of which their characters are capable. 
"I thank God I was called to China," said Miss C. 
F. Tippet, of the Wilson Memorial Hospital at Ping- 
yang Fu, when, in London, she addressed an audi- 
ence to tell of her work, and of "the women with 
their poor, bound feet, often literally rotten; the 
blind, made to see, and the lame to walk: If I had 
twenty lives they should all be spent there." And 
one martyr the nursing community has given to 
China. Among the five American missionaries mas- 
sacred at Lien Chow, one was Dr. Eleanor Chesnut, 
who, before taking her medical course, had graduated 
in the class of 1891 from the Illinois training school 
for nurses in Chicago. At the time of her death, Dr. 
Chesnut had a hospital for women and children at 
Lien Chow, and a dispensary ten miles distant. 
She had a class of Chinese women whom she was in- 
structing in nursing, another to whom she was 
teaching medicine, and blind pupils to whom she 
taught massage. She had become an expert scholar 

1 A. J. N. t May, 1908, p. 607. 



282 A History of Nursing 

in Chinese, and was making the translation of Isabel 
Hampton's Nursing, which her death interrupted. 
Her medical work was tremendous, and with it all 
she had collected a " family" of helpless dependents 
whom she supported. She loved the Chinese, and 
often said she would gladly give her life for China. 
In return she was dearly loved by her pupils and 
patients. z 

The foreign nurses in China have organised under 
the name, "The Nurses' Association of China," 
and their proceedings are reported in the Nurses' 
Department of the China Medical Journal. Their 
constitution declares one of its purposes to be "to 
raise the standard of hospital training in China by the 
adoption of a uniform course of study and examina- 
tion for the Chinese"; and to this end a registration 
committee examines into the intellectual training, 
moral standard, and hospital discipline of all hospital 
institutions under missionary, government, or private 
control, which may desire to register under the com- 
mittee. Three members of this committee of seven 
are Chinese nurses, and the general membership 
includes all qualified Chinese nurses who hold certifi- 
cates from schools registered as being of approved 
standards. Local branches are to be formed as 
steadily as possible, and the association recommends 
to all hospitals that they adopt a course of study and 
examination approved by the Medical Missionary 
Association of China and Corea. 

Representations were made in 1908 to the Central 
China Medical Association Board, emphasising the 

1 Bulletin, Illinois Training School Alumnce Association,NovembeT, 
1905. Article, "Eleanor Chesnut, M.D.," by Katharine De Witt 



China 283 

need of a unified, thorough training to elevate the 
standard of nursing in China, and this board agreed 
to conduct periodical examinations and give certi- 
ficates. In 1 910, the first ceremonious presentation 
of certificates thus gained was made to nurses from 
different parts of the Yangtse Valley. J 

The rules require a three years' training with theo- 
retical and practical instruction, and now, since 
central examinations are in force, membership in the 
nurses' association means that Chinese nurses have 
taken this examination. Of this successful piece 
of constructive work the leaders wrote: 

The venture has been a great success, and already 
there is the spirit of advance manifested. The nurses 
are showing more zest in their studies, and the feeling 
of competition impels them to put forth their energies in 
a way they have never done before. This impetus is 
needed more than ever, and it is still difficult to get in- 
telligent educated nurses. This is more particularly so 
amongst the girls, as the feeling that nursing is no more 
than an amah's or p'op'o's work, has not yet died away. 

These examinations and public presentation of certi- 
ficates are also helpful in stimulating the idea of unity 
between the hospitals, making nurses realise that they 
are not doing isolated work, but are growing into a great 
brotherhood and sisterhood in all parts of the Empire 
for the relief of suffering and the extension of the King- 
dom of God. 2 

The leaders in Chinese nursing organisation are 
Mrs. Caroline Maddock Hart, first president of the 

1 Nurses' Department, China Medical Journal, January, 191 1. 

2 Ibid. 



284 A History of Nursing 

Nurses' Association; Miss Mary C. Ogden, of Anking, 
her successor in office; Miss Nora Booth, of Hankow; 
Miss Maud T. Henderson, from the Boston City 
Hospital, at work in Shanghai in the Refuge for 
Chinese Slave Children, whose terrible stories had 
originally led her from America to China ; Sister Ethel 
Halley, Miss Margaret Murdock, of Hwaiyuan, and 
many others whose share in upbuilding cannot yet 
be fitly heralded. On the registration committee of 
191 1 stands Mrs. Ts'en, the first Chinese nurse to 
hold such office. 

Surpassing all other efforts in interest are those 
projects for medical and nursing schools in con- 
nection with hospital work which have been planned 
out and set on foot as national undertakings by 
the Chinese government itself. In this work, Dr. 
Yamei Kin, a woman, whose medical education 
was obtained in the United States, stands prom- 
inently forward, but, because of the immense revolu- 
tionary movement so recently at an acute stage, the 
triumphant success of constitutional principles, the 
(partial at least,) enfranchisement of Chinese women, 
and the resultant intense activity and absorption in 
home affairs, the full story of this large plan, which 
had been promised by Dr. Kin, must be postponed 
for some later historian. In the Tientsin Hospital, 
where Dr. Kin directs the Woman's Medical De- 
partment of the Chinese Government in North China, 
there is already a flourishing training school of forty- 
odd pupils, whose nursing superintendent is Miss 
Chung, trained at Guy's, in London. * Early in 191 1, 
Dr. Kin brought to the Unites States a young Chinese 

1 See Chinese Students' Monthly for March, 191 1, p. 479. 



Corea 285 

woman, who, after a college course, is to be trained at 
the Johns Hopkins school for nurses and return to 
China to continue the development of the service 
entrusted to Dr. Kin. We therefore leave China 
on the threshold of momentous changes. 

Corea. — Corea, too, has nursing progress to show. 
The names of nursing pioneers who blazed a path 
there include that of Anna P. Jacobson, whose life 
ended after a year and a half of service. She was a 
Norwegian, trained in the United States in the Port- 
land Hospital, Maine, and her character and labours 
made a deep impression on all who knew her. She 
went to Corea in 1895. In 1897, Esther L. Shields, 
of the Philadelphia training school, was in Corea, 
learning the language and making the beginnings of 
teaching natives. Her work later flowered fully when 
the Severance Hospital opened its well-organised 
training school for Corean women, with a good three 
years' course, in 1906, Miss Margaret J. Edmunds, 
from the Ann Arbor University Hospital (U. S. A.), 
in charge, full of enthusiasm and faith in the future 
of her work. "The Corean women have proven 
their ability to become throughly good nurses," she 
wrote. Miss Kimber's A natomy and Physiology, Miss 
Maxwell's and Miss Pope's Text-book on Nursing, 
and parts of Mrs. Robb's books have been translated 
into Corean. A Severance Hospital nurses' association 
has been formed, and a nursing journal for Corean 
nurses is talked of as the next professional need. 
The work at Severance is under the American Pres- 
byterian Board of Missions. 

It would take a volume to record adequately tht 



286 A History of Nursing 

growth of nursing in far places: In Aintab, Tur- 
key-in-Asia, the Memorial Hospital named for Dr. 
Smith opened a regular training class for native 
women in 1909-10, with Miss Alice Bewer, Phila- 
delphia Hospital, in charge, and Miss Charlotte F. 
Grant, of the Boston City, in the operating room. 
Four pupils were enrolled, and a course of study 
arranged from Miss Bewer's note-books and transla- 
tions from Hampton's Nursing and Nursing Ethics. 
The head nurse wrote: "On the whole, the work of 
the nurses has been most satisfactory and encourag- 
ing. Our hope for the future is to have properly 
educated girls come to take the course, but we must 
first have a proper place to house them, and equip- 
ment to make coming here attractive." 1 

In 1908, the missionary nurses working in Turkey 
were voted in as full members of the first conference 
of the Medical Missions Association of that country, 
and Miss North, stationed in Cesarea, reported excel- 
lent work in the training of native women. An asso- 
ciation of nurses in Turkey was then first suggested. 

In Syria, a wide influence has been exerted by 
Miss Edla Wortabet, an English nurse, who wrote 
a nursing text-book in Syrian. The training school 
of the Protestant College, at Beirut, graduated its 
pioneer class of three in 1908, with thirteen pupils 
entered and a waiting list of as many more. The head 
nurse, Miss Jane E. Van Zandt, of the New York 
Post-Graduate, wrote that the educational standard 
for nurses was very good and the outlook most 
hopeful. 2 

1 Bulletin, Central Turkey College, December, 1910. 
* A. J. N., January, 1909, p. 274. 




CO 



Corea 287 

In Greece, English nurses have shown a model 
of hospital work, and Greek maidens have crossed 
the seas for training to carry back for the service of 
their country. The first so to come to America was 
Kleonike Klonare, in 1900, to the Massachusetts 
General, and in 1904 came three Greek girls under 
the protection of one of the royal family. Two fol- 
lowed Miss Klonare to her alma mater and the 
third went to the Baptist Hospital in Boston. 

In Persia, amidst all sorts of difficulties, Miss H. 
D. McKim, of the Toronto General, worked loyally 
from 1903, and so in every corner of the earth the 
nurse's cap and pin may be found. 



CHAPTER VI 

SOME ISLAND HOSPITALS AND NURSES 

Collaborators: M. Eugenie Hibbard, Cuba; Mabel 
McCalmont, The Philippines. 

Cuba. — At the conclusion of the war with Spain in 
1908, the Sisters of the religious nursing orders in 
Cuba were withdrawn by their Motherhouses, and 
the officers of the United States army faced the 
difficulty of equipping the hospitals with an efficient 
nursing staff. 

One of the greatest problems presented to the govern- 
ment of the United States at the beginning of the occupa- 
tion of the Island of Cuba by the American forces was 
how to deal with the appalling condition of her hospitals. 
A visit to some of these places would remind one of the 
Dark Ages. They were dens of immorality and unclean- 
liness in every form. Their unsanitary condition was 
responsible for much of the sickness in the cities and sur- 
rounding country. No precautions were taken to prevent 
the spread of disease. In many instances, where expens- 
ive apparatus for the disinfection of clothing had been 
provided, it had never been used. Dirty water from the 
baths and laundries was often disposed of by being turned 
into the street. In some places, clothes were washed in 
the rivers without previous disinfection, to breed disease 

288 



Cuba 289 

wherever the river water was used. Those employed in 
the care of the sick were of the lowest type of humanity. 
The very name enfermero, attendant on the sick, was a 
term of degradation. « 

So wrote one of the well-known and active members 
of the nursing profession in the United States, who 
had gone to Cuba in the army service. 

The nursing service of the Sisters in the hospitals had 
been of a religious rather than a professional nature. 
Though under the supervision of the medical director, 
they were directly influenced by the Church, and owing 
to their vows were unable to perform effectively the 
duties of nursing. In domestic management their work 
was perfectly done. Evidence sufficient to convince the 
most sceptical could be found in the arrangement of 
linen-rooms, closets, storerooms, pharmacies, and kitch- 
ens, in the care of the linen used in the chapels, and the 
various aprons, gowns, etc., used by physicians and 
others. The pillow and sheet shams which decorated 
the patients' beds on saints' days were beautifully em- 
broidered and lace trimmed. No doubt great pride was 
taken in this department, but in actual nursing the 
Sisters' duties consisted principally in distributing wine 
and soup to the very sick ones, and praying beside the 
dying. 2 

By the voluntary withdrawal of the Sisters and their 
return to Spain [said Mrs. Quintard], the field was left 
clear for the introduction of American methods, and the 

^'Nursing in Cuba," by Lucy Quintard, in Transactions, Third 
International Congress of Nurses, Buffalo, 1901. 

2 " Cuba, a Sketch," by M. Eugenie Hibbard, American Journal of 
Nursing, August, 1904, p. 841. 

VOL. IV. — IO 



290 A History of Nursing 

men to whom this work was entrusted, recognising the 
herculean nature of the task before them in reorganising 
the hospitals, and realising their helplessness to accom- 
plish it single-handed, turned to the nursing profession 
for assistance, and met with a hearty response. Good 
women answered the call and went to work with a will, 
working early and late to co-operate in every way with 
the heads of the departments. 1 

Mrs. Quintard herself was one of the first to turn 
from the military nursing to reconstructive work. 
In the hospitals' crisis, Major L. J. Greble, head of 
the Department of Charities and Sanitation, secured 
her services and those of Miss Sarah S. Henry, and 
appointed them as special inspectors of hospitals to 
assist in the establishment of training schools for 
nurses in Cuba. They had both, at different times, 
previously held the important position of superin- 
tendent of the Connecticut training school, and Mrs. 
Quintard was one of its graduates. Before the war, 
she had been in charge of the training school of St. 
Luke's Hospital, New York. As special inspectors, 
these two women laid the foundations of Cuban 
training-school organisation, and during 1899 and 
1900 many appointments for the new work were 
made among the army nurses or those coming direct 
from the United States for the purpose. 

It was in a sense [said Miss Hibbard], much easier to 
rebuild on a comparatively vacant site, than it would 
have been to uproot and reorganise at the same time. 
So, regardless of the conditions that may have previously 

1,1 Nursing in Cuba." 



Cuba 291 

existed, the Americans could work unhampered by dicta- 
tion or tradition, though the customs of the people en- 
tered largely into their calculations. Through ignoring 
these, it would have been an easy matter to antagonise 
and destroy the prospect for good work. 

The majority of the hospitals were well located, 
well built, and with a certain beauty of their own. 
The Mercedes, in Havana, heads the list. In ap- 
pearance it is a modern building, and comparatively 
new. It is constructed on the plan of an English 
hospital, but modified to suit the conditions of the 
country. The wards are built on the pavilion style, 
securing light and air on three sides. The interlying 
spaces are beautiful, cultivated gardens, containing 
the shrubs and flowers peculiar to the country. All 
of its departments are well equipped and, at the 
time of the military occupation in 1898-99, it was 
the only institution which could receive or care for 
American patients. Its medical director was Dr. 
Nunez, a patriot, who had been deported by the 
Spanish government to the west coast of Africa, and 
had returned to Cuba after several years' absence. 
He readily co-operated with General Ludlow, General 
Brooke, and Major Furbush, all of whom were es- 
pecially interested and instrumental in establishing 
a high order of things, and in. August, 1899, the first 
training school was opened in this hospital, with 
seven pupils, under the direction of Miss Mary A. 
O'Donnell, a graduate of Bellevue, who had been 
working in the army service and whose contract with 
the United States was honourably annulled in order 
that she might assume her new position. Miss 



292 A History of Nursing 

O'Donnell thus holds the proud position of premier 
among American training-school heads in Cuba. * 

An earlier attempt had been made which must 
not be overlooked. In January, 1899, Dr. Raimundo 
Menocal had opened a school for nurses in the Havana 
Sanitarium. It had twenty-two pupils, who were 
placed in the charge and under the instruction of Dr. 
Vidal Sotolongo. This school, however, only existed 
for five months, the sanitarium being closed in May. 
Dr. Menocal remained interested and was actively 
helpful in the work of establishing the permanent 
schools. 

The public charities of Cuba were thoroughly 
reorganised in the early part of 1900, and Major E. 
St. John Greble became the first superintendent of 
the Department of Charities. It was placed under 
the general supervision of the Department of State 
and Government, and schools for nurses were opened 
in connection with the public hospitals in the follow- 
ing order: In 1900, in March, Hospital Civil, Cien- 
fuegos, with Miss Jeanette Byers, of the Woman's 
Hospital in Philadelphia, as superintendent; in 
September, Hospital No. One, Havana, with Miss 
Gertrude W. Moore, of Bellevue, who, three months 
later, was transferred to a fresh field, being replaced 
by Miss Holmes ; in October, Hospital Santa Isabel, 
Matanzas, with Miss Hibbard; in November, Hos- 
pital General, Puerto Principe, with Miss Mitchell, 
of St. Luke's, New York ; in the same month, Hospital 
General, Remedios, with Miss Samson, from Belle- 

1 During her stay in Cuba, Miss O'Donnell translated Mrs. Robb's 
Text-book into Spanish, and wrote notes of her own in the same 
language. 




A Group of Cuban Nurses 



Cuba 293 

vue; and in January, 1901, Hospital Civil, Santiago 
de Cuba, with Miss Moore, who had been transferred 
there from Havana. Each of these women had with 
her a staff of trained nurses, representing many of 
the schools scattered over the United States. 

Seldom, if ever, has so complete a transformation 
taken place in hospitals in so short a time, and in such 
wholesale fashion. On the retirement of Major 
Greble from the position of superintendent of the 
Department of Charities, Major J. R. Kean received 
the appointment, and the subsequent success of the 
schools was due largely to his personal interest and 
keen appreciation of the actual requirements at this 
critical period of the schools' existence. Like all 
men who have been successful in furthering the es- 
tablishment and maintenance of good nursing he 
was willing not only to be advised by nurses, but to 
accord them spheres of real responsibility, and to 
treat them as equals and co-workers. The results 
in Cuba have been so brilliant and so sound as well, 
that Major Kean and the women with whom he 
worked in harmony deserve a very special distinction 
among their fellows. No country has had a more 
carefully planned and wise design to develop and 
conserve a high standard of nursing education under 
the guardianship of the state, a standard which it 
has steadily upheld. In July, 1901, soon after taking 
office, Major Kean issued an order, reading as follows : 

Office Superintendent, Department of Charities, 
Havana, Cuba, July 16, 1901. By authority of the 
Military Governor, a board will be convened to meet in 
the office of the Superintendent of Charities, Havana, 



294 A History of Nursing 

Cuba, at twelve o'clock, July 22, 1901, or as soon there- 
after as practicable, to draw up a system of regulations 
for the training schools for nurses in Cuba. They will 
also fix the course and duration of instruction, the re- 
quirements for admission, the standard to be required 
before graduation, and make recommendations with 
regard to salaries and allowances. The board will also 
recommend a suitable manual for use in the nurses' 
schools, and in the hospitals under state control. The 
board will be composed as follows: 

Dr. Manuel Delfin, Vice-President of the Central Board 
of Charities, Havana; Dr. Emiliano Nunez, Medico- 
Director of Mercedes Hospital, Havana; Dr. Enrique 
Diago, Medico-Director of Hospital No. One, Havana; 
Mrs. L. W. Quintard, Inspector, Department of Chari- 
ties; Miss M. Eugenie Hibbard, Superintendent, School 
for Nurses, Matanzas. . . . 

(Signed) J. R. Kean, Major and Surgeon, United 
States Army, Superintendent Department of Charities. 

The meetings, several in number, were well at- 
tended, and by the end of August, 1901, a plan of 
general regulations was submitted for the approba- 
tion of the central board of charities. In October 
it was somewhat enlarged, made more comprehensive, 
modified in particulars, and again submitted. On 
January 3, 1902, the plan was approved in entirety 
by the military governor, General Wood. 

The object of these schools shall be, first, to further 
the best interests of the nursing profession by establishing 
and maintaining a universal standard for instruction, 
and providing students with the proper means of educa- 
tion in the practical care of the sick ; second, to secure for 
the student upon graduation a degree or title, which will 



Cuba 295 

be a protection in practising her profession, and be a 
recognised means of securing employment; third, to 
provide hospitals and institutions in the island with 
skilled service in the nursing department, and a proper 
number of graded assistants, thus conferring a benefit 
on the mass of suffering humanity. « 

So ran the preamble, the work of Miss Hibbard, 
which introduces one of the most creditable pieces 
of work that has fallen to the lot of American nurses, 
for the two women on this board practically framed 
the working plan and details of the training-school 
organisation for Cuba, their expert knowledge being 
readily deferred to by the Cuban physicians. Major 
Kean wrote later: "The Cuban law to regulate the 
education and the practice of the profession of 
nursing was drawn up under my supervision, but 
is in the main Miss Hibbard' s handiwork. ... It is 
considered a very advanced and satisfactory law." 

Miss Hibbard wrote : 

The aim and fixed intention of those interested in or- 
ganising these schools was to put them at once on the 
highest attainable plane, giving the result of similar 
work in other countries as sufficient reason for establish- 
ing a standard that would at once command the respect 
of the people and the self-respect of the accepted student, 
defining emphatically the position for the nurse in a 
country until recently ignorant of her existence. To 
start with a high standard is a more effectual way of 
attaining success, than placidly to allow conditions to 
evolve. 2 

1 Included in Governor's report, dated January 3, 1902, p. 989. 
'"Establishment of Schools for Nurses in Cuba," American 
Journal of Nursing, September, 1902, p. 989. 



296 A History of Nursing 

These schools are all in a healthy, flourishing condition, 
[wrote Mrs. Quintard in 1901]; they have been estab- 
lished on a good, firm foundation, and if the present 
status can be maintained, and good American nurses 
kept at the head until their own women have sufficient 
experience, after their training, to occupy positions as 
superintendents and head nurses, there is no reason 
why Cuba should not, in a few years' time, be able to 
boast of a fine nursing service in her hospitals, as well 
as of a thoroughly trained corps of women to meet the 
demands of private patients. 

This forecast has been realised. Under the pro- 
visions so wisely made, and as a result of the good 
standing given to the nurse, the schools were quickly 
filled with young Cuban women of refinement, whose 
families would never before have dreamed of con- 
sidering for a moment letting their daughters go into 
the wards of public hospitals to perform duties 
which, it had always been believed, no one but a 
religious Sister could perform without loss of woman- 
liness. 

The regulations, which are well worth repeating 
in full, shall be summarised briefly. The schools 
were to be state institutions, attached to hospitals 
for mutual benefit, but under the direct control of the 
Department of Charities. They might be established 
in all cities of Cuba where there were public hospitals 
of over one hundred beds, after previous approval 
by the department and inscription in the school of 
medicine at Havana. Not less than twenty students 
should be taken into a school. A committee, of 
which one member must be a graduate nurse having 
held superintendent's post, was appointed to deal 



Cuba 297 

with affairs of a general character affecting the 
schools, while a superintendent of nurses with 
trained assistants was to direct the pupils' training 
under the medical director of the hospital. 

The training course was to be three years, followed 
by the bestowal of a diploma by the faculty, which 
was to have the protection of the state. The practice 
of nursing without this diploma was forbidden. An 
eight-hour day was to be the rule, with twelve hours 
for night duty. Private nursing was forbidden for 
students, except for a three months' period during 
the final year if desired. Any fees received for such 
service were to be kept for a prize fund for nurses on 
their graduation, thus removing all mercenary motive 
for sending pupils out. The powers and duties of 
the superintendent of nurses were those usual in the 
best schools. Thus Cuba led the way in compulsory 
registration for nurses. 

Had it not been for the faithful manner in which the 
Cuban Central Board of Charities and Hospitals has 
adhered to the letter and spirit of Order No. 3, 1902 
[wrote a close observer in Cuba], the nursing profession 
in Cuba would have become demoralised long ago. 
There are a number of hospitals throughout the island 
maintained by fraternal societies of various kinds for 
the benefit of their members, and these institutions 
have tried to have their pupils take the university ex- 
aminations, but have been refused on the ground that 
their certificates of instruction and training are not 
from schools recognised by the National University. 
Sisters of religious orders have likewise been refused on 
the same ground. The word enfermero, nurse, may not 
be used except by a graduate of the recognised schools, 



298 A History of Nursing 

nor may institutions apply this title to other women. 
The graduate nurse is entitled to the protection of the 
courts. The non-graduates are not recognised. 

There is a roll of honour of the men in power who 
have consistently kept the standard of nursing to 
its original level: they are Dr. Emiliano Nunez, di- 
rector of the Mercedes Hospital; Dr. J. M. Pla, second 
director of charities and hospitals ; Dr. Carlos Finlay 
and Dr. Emilio Martinez, members of the Central 
Board of Charities; and Dr. M. Delfin, first director 
of charities and hospitals. With vigilant care and 
professional pride, they have kept close watch to 
prevent any signs of deterioration. 

The American nurses gave admirable service in 
the reformation of the Cuban hospitals. It was their 
first piece of work on a large scale outside their own 
country, and many made brilliant records. The 
whole number who took part in the achievement 
reached close to seventy-five. On the 31st of De- 
cember, 1 90 1, the lists in the official reports showed 
thirty-seven American nurses staffing the hospitals 
as head nurses or superintendents of schools. Many 
of them are now members of the order of Spanish- 
American War Nurses, by virtue of selection, ap- 
pointment, and duty performed as contract nurses 
in the United States Army, previous to December, 
1908. Among these were Rose Abel, Minnie Cooke, 
Wilhelmina Giesman, Frances McCurdy, Mariette 
Meech, Anna O'Donnell, Mary O'Donnell, Olive Pen- 
dill, Genevieve Russell, Anna Turner, Rosa Tweed 
(now dead), Hannah Waddell, Mary McCloud, 
M. Eugenie Hibbard, and Annie O'Brien. The last 



Cuba 299 

named is still (1910) in charge of Las Animas con- 
tagious hospital, a position that she has held for 
nearly ten years. 

Training schools all over the country were repre- 
sented in this list, which we cannot attempt to repeat 
in full: Blockley and Bellevue, St. Mary's of Brook- 
lyn, Grace of Detroit, Charity of New Orleans, and 
the Pennsylvania. Miss Pearson came from the 
Massachusetts General ; Miss Meech from the Illinois 
training school, and Miss Pendill from St. Luke's, 
Chicago. St. Luke's of New York furnished two 
superintendents, Miss Mitchell and Miss Robertson. 

As the schools became securely established, and 
the commencement exercises saw increasing numbers 
of young Cuban women entering the nurse's career, 
the Americans began to think of going home. The 
American occupation was passing, and United States 
officials were leaving the island. The nurses, it is 
said, were among those who were most welcome to 
stay to the last, even though, at first, their rigid 
standards of order and cleanliness had been more or 
less resented by the patients, who were sometimes 
heard to mutter "Cuba Libre" when they were under 
the hands of the women in blue and white. 

Promotion time for the young Cuban nurses came 
in 1909, when six of them were placed at the heads 
of training schools. The first appointed was Senorita 
Rosa Sieglie, to the Santa Isabel, Matanzas, a post 
that she held for six years. Martina Guevara went 
to the Mercedes, in Havana; Trinidad Cantero, to 
Hospital No. One; Rosa Gallardo, to Cienfuegos; 
Victoria Bru, to Camaguey; and Hortensia Perez 
to Santiago de Cuba. 



300 A History of Nursing 

Preventive social work now received the attention 
of the Cuban patriots and war heroes, and Miss 
Hibbard was selected to organise a corps of visiting 
sanitary nurses which should constitute a special 
service under the Department of Health. The 
members of this corps included three of the retiring 
American superintendents, Miss M. A. O'Donnell, 
who had a record of nine and a half years' continuous 
service; Miss M. Jeanette Byers, who had served 
six years as a superintendent and had been in Cuba 
for eight or nine years in all; Miss Mary E. Pearson, 
who had a similar record, and three Cuban nurses, 
Senoritas Adelada Jimanez, Rosa Luisa Ortiz, and 
Emma Deulofeu. 

Miss Hibbard' s nursing career merits more than 
passing mention. Half Canadian and half American, 
she was trained in the historic school of St. Catha- 
rine's, and had made a reputation in hospital and 
training-school administration when the war with 
Spain broke out. Her vacation was spent in the 
typhoid camps, and an eventful war service followed. 
This was concluded by her voyage to South Africa 
as Superintending Sister in charge of the hospital 
ship Maine. She was called to Cuba in 1900, and 
after two years there, was appointed by the Isthmian 
Canal Commission as chief nurse in the Ancon Hos- 
pital, Panama. Of the two and a half years spent 
there, she said: "There was, I realised, a stupendous 
piece of work before us, and so it proved to be : most 
difficult at the time ; now the most satisfactory piece 
of organising work I have done." (Two Belle vue 
nurses, Miss Markham and Miss McGowan, ac- 
companied her to the isthmus.) Recalled to Cuba 




*s 



I * 



r 






, 



M. Eugenie Hibbard 

A Leader in Cuban Nursing 



Cuba 301 

in 1908 as inspector-general of nurses, and, in 1909, 
entrusted with the responsible duty of developing 
instructive visiting nursing for the republic, she has 
been identified in a very special way with the growth 
of Cuban nursing. 

In the new work, she and her staff came into close 
relations with the secretary of the department, Dr. 
Matias Y. Perdone Duque, man of science, revolu- 
tionist, and altruist. He had served in the war under 
General Gomez, and afterwards rose by a series of 
promotions to be the first Secretary of Health and 
Charities, a cabinet office, newly created, than which 
there is no more important position in Cuba, as her 
relations with the United States bind her to main- 
tain a satisfactory sanitary condition throughout the 
republic. 

Among the many innovations of the new depart- 
ment was an active anti-tuberculosis campaign, inau- 
gurated by Dr. Duque, for the success of which the 
hospitalisation of the tuberculous was regarded as 
being of first importance in the suppression of the 
disease. A corps of medical inspectors, with the nurs- 
ing staff, was organised to investigate the living con- 
ditions of tuberculous patients, and Dr. Duque was 
hopeful of relieving the helplessness and misery of the 
poor in their homes by improvements in housing con- 
ditions, and the enforcement of preventive measures 
making for the suppression of transmissible diseases. 
A service of medical school inspection was also es- 
tablished. The training schools for nurses received 
special attention from Dr. Duque, that they might 
continually advance and maintain the highest pos- 
sible standards. To promote educational progress, 



302 A History of Nursing 

the creation of post-graduate courses on special 
subjects was undertaken. 

How striking the contrast between the old and the 
new regime, and how remarkable the results gained 
in one decade of teaching young and impressionable 
women the possibilities of public duty and social 
usefulness under freedom, was brilliantly demon- 
strated when two Cuban nurses appeared at the 
London Congress in 1909, to report on their country. 
This happy event was brought about by the kind of- 
fices of Miss Hibbard, and the liberal attitude of Dr. 
Duque toward the nurses and their work. It was 
his desire to have the Cuban delegates sent officially 
by the government, but, the non-official nature of 
the congress making this impossible, they were sent 
as delegates from the Department of Health and 
Charities. The nurses chosen were Miss Marguerite 
Nunez and Miss Mercedes Monteagudo. With them 
came Miss Hibbard. They brought the kindest 
letters from Dr. Duque, whose interest in high 
standards of education, and desire that the young 
nurses should enter the international group, were 
fully appreciated. Miss Nunez brought with her a 
paper describing the schools for nurses, as here im- 
perfectly outlined, and added the plan for extending 
modern methods to the care of the insane, saying: 

Our nurses receive experience in all branches of nursing. 
In the insane asylum, in our National Manicocomium, 
there exists a school for special nurses ; but the specialty 
does not consist in more advanced studies, but in dedica- 
tion to that branch of medicine, without acquiring, how- 
ever, other knowledge than that necessary to take care 



Cuba 303 

of the poor lunatic. This is, of course, a defective or- 
ganisation, and the nurses who graduate from this school 
have not acquired a general knowledge of nursing. At 
present the Secretary of Health and Charities is giving 
the school a more scientific and practical organisation. 
He now intends that only graduate nurses shall take this 
special course, and shall receive a diploma qualifying 
them to care for mental cases, provided, of course, that 
they pass the examinations. Our Manicocomium is 
situated some nine miles from Havana, on a large estate, 
and the asylum has accommodation for 2.S00 patients, 
which is an evil, because the unfortunate insane cannot 
be sufficiently well attended, especially from the medical 
point of view. 

The school for nurses annexed to this asylum will now 
open with ten undergraduate and eighteen post-graduate 
students, and eighteen young ladies more, who will ac- 
quire the knowledge sufficient for the mechanical care, 
if I may be permitted the expression, of the insane. 
After next August, it will be in charge of Miss Walker, 
of the United States, who, until a year ago, was the 
directress of the school in Hospital No. One in Havana 
and from whom I expect the best results, in view of her 
fitness, her energetic character, and her intense fondness 
for work. The government of Cuba, on the advice of 
the present Secretary of Health and Charities, has sought 
in the city of London two young ladies with expert 
knowledge of mental diseases, in order to appoint them 
professors of our school. ... My colleagues, as well as 
myself, entertain very great veneration for our teachers, 
and I should especially mention Miss O'Donnell, who 
was my teacher, and more, my good and kind friend 
and counsellor, who with her advice gave me strength to 
face the sad scenes of the hospitals at the beginning of 
my professional studies. To this noble woman I am in- 
debted for what little I am, and if I have not achieved, 



304 A History of Nursing 

the fault is not hers, but my own insufficiency. . . . 
I do not claim that the schools for nurses in Cuba are 
organised in a perfect manner. There are certain short- 
comings which the Director of Charities, Dr. J. M. Pla, 
intends to correct, in order that the schools may be com- 
plete, and with respect to these reforms much depends 
on my observations and studies here. . . . 

As mentioned by Miss Nunez, two English nurses, 
specially trained in the care of the insane, were in- 
vited to Cuba, but with the regretted resignation of 
Dr. Duque (for political reasons), in October, 1909, 
the arrangement of work at Mazorra had gone back- 
ward. His successor returned to the old methods, 
and the English nurses, whose work had been ex- 
cellent, went home. 

The state hospitals of Cuba now employ ninety 
odd nurses in permanent positions. They are dis- 
tributed among the institutions receiving state ap- 
propriations, of which there are twenty-three aside 
from the training schools, the latter being classed by 
themselves. The republic yearly sets aside an appro- 
priation sufficient to educate one hundred and eighty 
probationers, and, since 1902, one hundred and 
ninety-six nurses have received the state diploma. 
It seems probable that Cuba will not be overstocked 
with nurses; nearly twenty per cent, marry, and 
marry well. Signorita Marie Sieglie became the 
wife of Dr. Finlay, son of Dr. Carlos K. Finlay, 
who w r as the first to suggest the possibility of the 
transmission of yellow fever by mosquitoes, and 
who received for this service the decoration of the 
Legion of Honour from France. 



Cuba 305 

If we should now, in 19 10, follow up the first set 
of Cuban graduates of training schools for nurses, we 
should find Manuela Barreras, Rosa Gallardo, Martina 
Guevara, Mercedes Monteagudo, and Rosa Sieglie 
holding superintendents' positions; Trinidad Can- 
tero studying medicine, Marguerite Nunez inspector- 
general of training schools, Aurelia Perez occupying 
a post in the hospital division of the women's depart- 
ment in the prison of Havana, Caridad Tuduries 
night superintendent in a large hospital, twenty-two 
others in head-nurse positions, one in private duty, 
and three at home. Two have died, and twenty- 
three have married. The Cuban nurses have also 
had their first emergency service in a national dis- 
aster. A letter, describing this, said: 

We had a very serious explosion of dynamite at Pinar 
del Rio, about six hours' ride from Havana. The news 
immediately telegraphed to the President, reached him 
at six o'clock, an hour after the accident. Relief was 
organised at once. The President sent the Secretary of 
Government with assistants to keep order, the Secretary 
of Public Works with a staff to remove the living and 
dead from the wrecked buildings, and the Secretary of 
Health with eighteen nurses and ten physicians to assist 
in the care of the wounded. All left Havana on a special 
train, leaving at 7.30. The nurses, under Senorita Mar- 
garita Nunez and Senorita Martina, the superintendent 
of Mercedes Hospital, are doing excellent work, and have 
been on duty since the accident happened. This is the 
first time the Cuban nurses have been depended upon to 
help in time of national disaster, and I do feel so proud 
of them. All I hear so far is praise of their work, and 
appreciation of the spirit they have shown. The nurses 

VOL. IV. — 20 



306 A History of Nursing 

went by government order, as they could be mobilised 
much more quickly than under the Red Cross. x 

The Governor of Pinar del Rio afterwards sent a 
silver commemorative medal to each of the nurses. 

The first Cuban pioneer to other countries has also 
gone forth in the person of Senorita Maria Luisa 
Aguirre, who has replied to a call from Panama to 
become assistant superintendent in Santo Tomas 
Hospital. Dazzling visions of future opportunities 
opening before the nurses of Cuba in transforming 
the hospital situation throughout the whole of the 
South American continent rise before the eyes, as 
one contemplates the annual group of alumnas sent 
forth from the Cuban hospitals. By their birth and 
language, their knowledge of the customs and habits 
of tropical countries, their experience of what sanita- 
tion has done in their own land, and their triumphant 
success in demonstrating the ability of the daughters 
of the south to take command, they are clearly the 
ones in line for this oncoming immense piece of up- 
building. There can be no doubt that, in a few years 
more, advance guards of Cuban nursing battalions 
will begin penetrating these as yet non-nursed coun- 
tries, carrying into them a practical application of the 
principles of prevention of needless disease and 
misery. And may it not be possible that the Spanish 
nursing field is also waiting for the Cuban nurses? 

The National Association of Nurses of the Republic 
of Cuba was established March 29, 1909, and within 
one year numbered three hundred members. Its 
first honorary member was Senora America Arias de 

1 Letter from Miss Hibbard, May 23, 1910. 




Isabel Mclsaac 



Formerly Superintendent of the Illinois Training 

School and then Interstate Secretary; 

Head, Army Xurse Corps 



Porto Rico 3°7 

Gomez, wife of the President of the Republic. 
Rightly directed, their association will be the most 
powerful organ that the nurses can have for main- 
taining their professional and ethical standards. 

Porto Rico. — Porto Rico has also a record of good 
work done. There are two excellent training schools 
in the island, one in the Presbyterian Hospital which 
is under mission auspices, and the larger insular school 
connected with the Municipal Hospital. The latter 
was founded and placed on a firm basis by Miss Amy 
E. Pope, from the New York Presbyterian. She had 
there, as assistant, a young Porto Rican, Senorita 
Pilar Cabrera, who had been trained in Baltimore 
at the Mercy, then the Baltimore City, Hospital. 

When Miss Pope returned to the United States, 
Miss Cabrera was made superintendent of the school, 
and amidst her other work translated into Spanish 
the text-book which had been written by Miss Max- 
well and Miss Pope together, and which spoke the 
latest word in scientific nursing. Miss Cabrera also 
trained a class of ten Sisters of Charity besides her 
group of lay pupils, who number about twelve in a 
class. She feels deeply gratified with their earnest- 
ness and capability, and is hopeful for the future of 
nursing in her native land. 

The Philippines. — Nursing in the Philippines has a 
history on which we may look back with satisfaction, 
for, while carried on almost entirely by Americans in 
the early days of the occupation, its speedy adoption 
into the life and education of the Filipinos themselves 



308 A History of Nursing 

and its wonderfully rapid development have probably 
not been surpassed elsewhere. 

There were about one hundred and twenty-five, 
in all, of American nurses who, in the army service or 
under the Red Cross, came to the islands during or 
soon after the war with Spain. Interesting as their 
story would be, their work was not especially signifi- 
cant in relation to the development of the nursing 
profession, for, as soon as their immediate duty was 
fulfilled, most of them left the islands. Some few 
Red Cross nurses joined the army service, but with 
the adoption of civil government the army nurse corps 
has been gradually reduced. The work of the army 
and navy nurse will always be localised and devoted 
practically to Americans; the real nursing of the 
Philippine Islands — the work that will reach the 
people — will be dependent upon, and represented by, 
the nurses employed by the civil government, those 
of private institutions, and lastly, but most important, 
by the native trained nurses themselves. 

The Bureau of Health, in charge of all civil govern- 
ment hospitals in the Philippines, with their accom- 
panying nursing force, directs and operates the Civil 
(now the Philippine General), Bilibid, and San La- 
zaro, all of Manila; the Baguio at the summer capital, 
the Tuberculosis at the San Juan tuberculosis camp, 
and the Culion Leper Hospital. It is also responsible 
for the medical and sanitary inspection of the islands, 
besides aiding many private hospitals and charitable 
organisations. 

The Civil Hospital of Manila was originally 
founded for the purpose of furnishing free treatment 
to all insular government employees, besides doing 



The Philippines 309 

private and emergency work. It has now been 
merged into the beautiful and commodious Philippine 
General, doing the work of any large city hospital, 
and open to all nationalities. The San Lazaro takes 
care of cholera, small-pox, and other communicable 
diseases, with special departments, in charge of native 
helpers, for leprosy, insanity, victims of drug habits, 
etc. The Bilibid is connected with Bilibid prison, 
and is a very complete new hospital with a capacity 
of four hundred beds, the work carried on at present 
by native attendants under direction of an American 
nurse. Pupil-nurses will soon be placed there for 
training. The Baguio is intended for sick and con- 
valescent insular government employees, as well as 
for the Igorots, a semi-civilised tribe, in the heart 
of whose country Baguio is situated. The Igorots 
are a bright, friendly, tractable people, and each day 
the dispensary at Baguio treats and cares for a large 
number of them. New hospitals have been planned 
for Cebu, the second largest city in the Philippines; 
at Bontoc, especially for the mountain tribes; at 
Sibul Springs, and in several other sections. All 
new hospitals erected in the Philippines, with a few 
minor exceptions, are of reinforced concrete, — fire- 
proof, earthquake- and storm-proof; with equipment 
of the most modern character, and with nursing 
performed almost entirely by the Philippine training 
school for nurses under the supervision of American 
nurses. 

The Culion Leper Colony is the largest in the world. 
There are at present about 2200 lepers there, and but 
a few more segregated and awaiting entrance. The 
completion of the segregation of the lepers of the 



3io A History of Nursing 

Philippines marks an epoch in the health history of 
the islands. At the colony there is a large modern 
hospital, recently completed, with a capacity of sixty 
beds. Lepers are, of course, subject to every other 
disease, and the hospital treats beriberi, small-pox, 
dysentery, and other tropical diseases, in addition 
to the extreme cases of leprosy. The work is carried 
on by two American physicians and six French 
Sisters of Mercy. There have been applications for 
a number of American and English nurses desirous 
of doing this work, but thus far it has not been con- 
sidered advisable or desirable to take the work out 
of the hands of the Sisters, who are very happy and 
contented there. Their sweet cheerfulness means 
not only a very great deal to the unfortunate lepers, 
but is a lasting inspiration to every thoughtful person 
visiting Culion. The work does not mean life-long 
isolation, as many suppose. The non-leprous em- 
ployees, priests, and Sisters, with proper disin- 
fecting precautions, go and come from Manila as 
often as they have the opportunity. It is a great 
field for missionary work, the children of the colony 
being dependent upon the busy Sisters for their 
schooling, moral training, etc. 

In addition to the foregoing work, three great 
health campaigns have been started by the Director 
of Health. One is for the reduction of infant mortal- 
ity ; another, a great hook-worm campaign ; and the 
third, against the omnipresent tuberculosis, a scourge 
that has attained the same appalling stature in the 
Philippines as in other countries. Towards the re- 
duction of infant mortality, creditable work has been 
begun, chiefly by Filipino doctors and philanthropists, 



The Philippines 311 

but it is a work wherein American nurses must 
eventually figure, in the way of supervision at least, 
and where graduate Filipino nurses will soon be of 
inestimable value. With an infant mortality of 
forty -four per cent, (of total number of deaths), there 
is an immense field right here for visiting nurses* 
settlements. 

Investigation has shown the impaired health and 
weakened condition of the Filipino people (who are 
not a strong or enduring race) to be largely due 
to the prevalence not only of tuberculosis, but of 
the hook-worm disease, which seems to have no 
equal in its capacity to enervate and undermine the 
system. Nurses have thus far not entered this work, 
but it is believed that the graduate male nurses will 
soon play an important role in this and similar fields, 
as their training has been planned particularly to fit 
them for the general health work of the islands. 
The third campaign was begun by the organisation 
of a society for the prevention of tuberculosis, and 
received its great impetus during the official visit of 
the Secretary of War in 19 10. To be successful it 
must be an educational one, and must be carried on 
by the schools as well as by the Bureau of Health. 
Education concerning the prevention of disease has 
been made a particular feature of the new curriculum 
of study planned for the Philippine training school 
for nurses. 

The rest of the nursing work done in Manila is 
accomplished by the University Hospital, St. Paul's, 
the Mary Johnson Memorial, San Juan de Dios, 
and Sampaloc's. The University is an Episcopal 
hospital of about thirty beds, with a force of 



312 A History of Nursing 

American nurses and a training school of Filipino 
pupils. Two settlement workers are also main- 
tained here — young, enthusiastic women who are 
doing splendid work with an orphanage, the establish- 
ment of a most successful women's exchange, neigh- 
bourhood visiting, children's classes, etc. St. Paul's 
is a large Catholic institution of about two hundred 
beds, conducted by French Sisters of the order of 
St. Paul de Chartres. Here, for a couple of years, a 
training school of twenty pupil-nurses has been under 
the direction of two American nurses. The nurses 
in charge, however, have recently been dispensed 
with, and the wisdom of this policy, so far as the 
pupil-nurse is concerned, is yet to be demonstrated. 
These French Sisters also conduct the Sampaloc 
Hospital, an institution of sixty beds, supported by, 
and maintained exclusively for, the prostitutes of 
Manila. The Mary Johnson is a small mission 
hospital of the Methodist Episcopal Church. A 
successful training school is being conducted here, and 
much excellent work done, particularly along the 
lines of maternity work and infant hygiene. San 
Juan de Dios is a Spanish institution conducted by 
Catholic Sisters for the benefit of orphans, the feeble- 
minded, the insane, and paupers. 

The Philippine General was established in October, 
1902, with Miss Julia Betts, a former Red Cross and 
ex-army nurse in charge, and two attendants for 
assistants. The capacity, then about forty beds, 
rapidly increased to eighty, with eighteen nurses, 
and ten or twelve male attendants. An old Spanish 
house with several others on the same property had 
been utilised. Lack of plumbing and other facilities 



The Philippines 313 

made the establishment and conduct of this hospital 
an heroic task. The practical completion of the 
Philippine General in August, 1910, was therefore a 
welcome relief to the entire city. The new hospital 
is doubtless one of the most beautiful in the world. 
The entire scheme is designed to accommodate one 
thousand patients. There is a nursing force of 
twenty-five American supervisors, with about one 
hundred and fifty Filipino nurses of both sexes. 

The establishment of a training school for Filipino 
nurses was agitated shortly after the American oc- 
cupation, and a bill for that purpose was put before 
but failed to pass the Commission as early as 1903. 
The project was one of the many admirable recom- 
mendations of Major Edward C. Carter, Surgeon 
U. S. Army, and the Commissioner of Health of the 
Philippine Islands during 1 903-1 905. The necessity 
of such a school seemed very apparent to him, but 
new projects move slowly, and it was not until 1907 
that the training of nurses was introduced as a spe- 
cialised branch of the Philippine Normal School, 
under Miss Mary E. Coleman, for six years dean of 
women there. To her and to Mrs. Jaime de Veyra, 
one of the most progressive of Filipino women, 
belongs largely the credit of successfully launching 
this most important movement. 

The idea of women nursing was an entirely foreign 
one to the Filipino people. To them the work 
seemed menial and wholly beneath a person of any 
family or birth. Not only did this idea have to be 
entirely overcome with both parents and young wo- 
men, but the latter, as students, had to be grounded 
in the very a-b-c of hygiene and sanitation, — nidi- 



314 A History of Nursing 

mentary knowledge which, in our country, is assimi- 
lated we know not when or how, — it is almost inborn. 
It is difficult for us to realise that some of the most 
primitive customs prevail among persons of more or 
less education in the Philippines. All this was up- 
hill work, but the school was finally started. Another 
struggle was involved in the donning of a uniform. 
The Filipino has worn the same style of costume 
for about three hundred years. This dress has a 
long train which carries with it class distinction. 
It is almost symbolical of the leisure or wealthy 
upper class: the longer the train, the higher the 
class; absence of train, lack of class. To abolish 
this costume, even for the period of "duty," was, 
therefore, something to accomplish, but it was done, 
and the student nurses now look most attractive in 
their striped, gingham uniforms, with white caps and 
aprons. Pleasant to relate, they have really become 
very proud of them, though they return to their 
native costumes as soon as off duty. The wearing 
of shoes and stockings came with this change, for 
the majority of Filipinos go bare-legged, with a 
simple sandal to protect the foot. 

Miss Charlotte Layton had charge of the theo- 
retical work of this school (under the Bureau of Edu- 
cation) for about the first two years of its existence, 
or until it was turned over to the Bureau of Health 
by an act of the legislature. The school started with 
sixteen scholarships, ten furnished by the govern- 
ment, and six by private individuals. After one 
year's study in the normal school, six of these student 
nurses were sent to St. Paul's for practical work, 
three to the University, and seven to the Civil Hos- 



The Philippines 315 

pital. After a short time, St. Paul's bought over 
their six scholarships and used these nurses as a 
nucleus for their own training school. The Univer- 
sity Hospital did likewise. The class of seven sent 
to the Civil Hospital remained intact, and was the 
first graduating class under the civil government. 
The school now has an enrolment of thirty, the 
maximum number of one sex allowed by law. 

When Miss McCalmont took charge of the nursing 
force in the Philippines, a peculiar state of affairs 
existed. All male patients, even the Americans, were 
cared for by male attendants only. In the men's 
wards, the nurses did only desk work, charting, and 
giving out medicines. Baths, treatments, and nearly 
all surgical dressings were done by the attendants, 
who were generally ex-army corps men, with even 
less than the ordinary training. There were many 
instances of neglect, and the situation was altogether 
unsatisfactory. It seemed impossible to get the 
nurses back into the hospital habits of the United 
States, and an attempt was made to solve the prob- 
lem by a training school for men. This, at first, 
was greatly discouraged, but finally put into effect 
with marked success. In March, 19 10, a training 
school for hospital attendants was opened with an 
enrolment of sixteen pupils and a surprisingly long 
list of applicants. This was merged a few months 
later with the training school for young women, and 
with practically the same curriculum of study. 

It had not proven satisfactory to have the theo- 
retical work conducted under one bureau, and the 
practical work under the direction of another; con- 
sequently, by an act of the legislature, the training 



316 A History of Nursing 

of nurses of both sexes was put under the direction 
of the Bureau of Health, with Miss Mabel E. Mc- 
Calmont as supervising nurse, and Mrs. Eleanor 
Underhill Snodgrass as superintendent of nurses. 
Under this act, appropriation was made for sixty 
government scholarships yearly. A thorough course 
of study was arranged, including, besides all the 
usual subjects, the nursing of tropical diseases, the 
sanitary work of the Bureau of Health, public instruc- 
tion in dispensary and school work, English grammar 
and colloquial English, and industrial and living 
conditions in the islands. The elementary course was 
planned to cover two and a half years of satisfactory 
work, with elastic modifications to meet the special 
conditions of race and climate. The preparatory 
course of six months gives the pupils from five to 
six and a half hours daily in diet kitchens, laundry, 
supply-rooms, etc., to familiarise them with hospital 
routine. Class work and demonstrations are given 
daily, while lessons in English are of first importance. 
Ward service is not entered on until the preparatory- 
course has been successfully completed. The junior 
year has six and a half hours of daily ward work, 
with one period of class daily for five days of the 
week. The senior year brings eight hours' ward 
work, with one lecture weekly, but no classes. The 
pupils, during training, pass through every branch 
of practical service. Those who have finished high 
school or have had superior educational advantages 
are chosen in preference to others. 

In the work of nursing and health education, which 
is of such vast significance and importance to the 
Filipino people, there are certain fields which neces- 



The Philippines 317 

sitate special training for those undertaking the 
work. These are along the lines of administrative 
or executive hospital work; dispensary management 
and public instruction; school teaching along the 
lines of hygiene, sanitation, and practical nursing; 
and sanitary inspection, — the last-named course de- 
signed for the male nurses particularly. Post-grad- 
uate courses of six months will be given in each of 
the above subjects. Graduates will be selected who 
have shown particular ability along these lines, and 
during their post-graduate course they will be paid 
thirty pesetas per month, with subsistence, quarters, 
and laundry. After completion of this course they 
will receive appointments and salaries in proportion 
to their ability. There are probably no other posi- 
tions in the islands where the work is as remunerative, 
as interesting, and of such great importance to the 
people. These special courses will open up lines of 
work which it is believed will be especially attractive 
to the Filipino student and for which it is believed 
he is particularly adapted. 

To establish the Filipino people physically is to 
insure their future effectiveness and prosperity. It 
should be the basis of all the educational work 
of the islands. To decrease the high infant mor- 
tality, to stamp out small-pox, cholera, tuberculosis, 
malaria, hook-worm, beriberi, and many other 
diseases which are retarding the progress of the 
Filipinos is absolutely necessary in order to build 
scientific and industrial education on a substantial 
foundation. This great work can not be accom- 
plished in any other way than through the education 
of the people. And the instruction of the masses 



318 A History of Nursing 

can only be accomplished through the specialised 
education of a selected number, who will then spread 
the leaven of their instruction, in the dialects of their 
own people, among those who have grown up in 
ignorance and superstition. 

This, then, is the object and purpose of the Phi- 
lippine training school for nurses. These young 
men and women, from all sections of the islands, are 
to be trained not only in the care of the sick, 
but in the prevention of sickness. They are to 
be given the best knowledge obtainable along the 
lines of nursing, hygiene, and sanitation. They are 
to be given this knowledge in such a way, it is hoped, 
that, even without expensive equipment, they can 
apply their instruction in a practical manner in the 
homes of the poor and those of moderate means. 
They will be able to disseminate this knowledge, 
either in hospital work in Manila or in the provinces, 
where provincial hospitals and dispensaries are now 
rapidly to be built; in the schools, teaching it as a 
specialised branch; in the provinces, as sanitary 7 in- 
spectors; or in the work of public instruction, viz., 
in dispensaries, where persons may come and receive 
free instruction in the care of the sick, the bathing, 
feeding, and care of infants, the elementary principles 
of nursing, the proper preparation of food for both 
the sick and the well, the prophylaxis of tuberculosis 
and other communicable diseases, etc. 

For the present, it seems wisest to spread as much 
knowledge of hygiene and sanitation as possible, mak- 
ing a feature of preventive rather than curative mea- 
sures. As the work develops, however, it will have to 
be more and more modified to suit the living condi- 



The Philippines 319 

tions of the country at large, and more particularly 
adapted to the people of the isolated provinces. This 
will be a task beset with difficulties. The problem is 
comparatively simple as far as the nurses are concerned 
who are being fitted for hospital work in Manila or 
other large towns, but for those who will be expected 
to carry their training and skill into remote and semi- 
civilised regions, the task is a formidable one. 

The tao or peasant class comprises a widely- 
scattered, poverty-stricken population living in ignor- 
ance and superstition, and hopelessly content to do 
so. They speak nearly sixty different dialects, none 
intelligible to the others. To give the Filipino nurses 
a training adequately adapted to the primitive con- 
ditions of living found in these provincial districts, 
is the serious problem awaiting solution at the hands 
of those responsible for the training of these student 
nurses. No other educational movement in the 
Philippines has, as yet, been thus practically solved, 
and it would be a triumph almost beyond realisation, 
if this, one of the greatest movements on foot in the 
islands, should be thus successfully launched and 
steered through the rocky course all progressive and 
pioneer movements must run. 

The problem is largely economic. The average 
Filipino subsists on probably less than ten centavos 
(five cents) a day. He lives in a primitive, one- 
or two-room shack with his entire family and 
much of his live stock. Cooking utensils are of the 
fewest possible number; knives, forks, and spoons 
for eating purposes are unknown ; the stove is a shal- 
low earthen vessel in which charcoal is burned, and 
over which the entire dinner is generally cooked in 



320 A History of Nursing 

one pot or pan. There are no beds or bed-linen. 
The family squat on the floor at meal-time, gathered 
around the common stew-pot, and eat with the 
fingers. The diet consists generally of rice, fish, or 
chicken, and a few uncultivated native fruits and 
vegetables. No water is safe to drink unless first 
boiled, but, needless to say, very few Filipinos take 
this precaution. 

Among those people, skin and venereal diseases, 
tuberculosis, dysentery, malaria, cholera, small-pox, 
beriberi, and other tropical diseases are liable to 
occur. Unless within reach of the comparatively 
few hospitals as yet constructed in the Philippines, 
such diseases will have to be cared for in these poor 
homes. The young graduate nurses, most of them 
from very good families and reared in comparative 
comfort, all of them receiving their training in a most 
modern hospital with an unlimited amount of com- 
plicated and expensive equipment, with American 
standards of living, cooking, and eating developed 
almost to the exclusion of their own, — what are these 
young nurses going to do after they have left the 
hospital and its careful supervision? 

As a people they lack the American ingenuity, 
inventiveness, and adaptability, though, like the 
Japanese, they are clever imitators. But unless 
they are taught to apply fundamental principles to 
such crude conditions as have been described, they 
will surely flounder. Unless they are trained to de- 
vise a proper dietary out of rice, dried fish, and vege- 
tables, realising that the only milk supply comes out 
of a tin can and at a prohibitive price; unless they 
can manage a hot and cold sterile water supply with 



The Philippines 321 

no convenient tap to turn which would give them 
both; unless bathing and cleanliness can be made 
possible with an almost total absence of soap and 
linen; unless a few poor utensils can be made to 
serve the manifold needs of the sick ; unless they are 
really trained to do all this at a minimum cost, then 
only to a limited extent will their training be of use 
to themselves, their people, and to the country at 
large. And only by such measure of usefulness and 
adaptability can the success of training Filipinos be 
guaged. To have a large training school of bright, 
eager young people, making phenomenal progress in 
theoretical work; to have a bulging list of applicants 
clamouring for admission, is not enough. That much 
only means that these most likable, responsive 
Filipinos see their opportunity and are ready and 
willing to do their part. The question is, can we 
and will we wisely do ours? 

[The work done by Miss McCalmont and Mrs. 
Snodgrass in the Philippines merits a few words of 
detail. The former nurse, graduate of the Homoeo- 
pathic Hospital in Washington, D. C, not only re- 
organised the entire nursing service of the Civil 
Hospital, but also, while holding the position of 
hospital superintendent, reduced the running expenses 
under circumstances of such peculiar difficulty as 
to make her work a piece of real civic duty, fearlessly 
done, for which she received the thanks of the admin- 
istration. She also designed the plans and ordered 
the equipment of the Philippine General as well as of 
provincial hospitals for the interior. After accom- 
plishing this task, she returned to the United States 
and gave an interesting example of the variations in 

YOL. IV. — 21 



322 A History of Nursing 

work possible for nurses, by opening a career as con- 
sultant in hospital construction and furnishing. 

Mrs. Eleanor Underwood Snodgrass, graduate of 
the S. R. Smith Infirmary, Staten Island, and of the 
special course in Hospital Economics at Teachers 
College, was a woman whose ability and lovable 
characteristics gave promise of the brightest future. 
When she became superintendent of nurses in the 
reorganised training school, it was generally felt that 
not only success, but distinction, awaited her, — an 
outlook too soon clouded by her death only a year 
later. Miss Margaret Wheeler and Miss Elsie Mc- 
Closky succeeded to the direction of the work left 
by the two pioneers.] 

The sketches of nursing development we have 
here given show, we believe, in a very striking way, 
the gradual change from the " sick nursing " of past 
ages to the "health nursing" foreseen by Florence 
Nightingale. The conquest of disease is rapidly 
extending, and as it does, the nurses' sphere will 
also change, until, perhaps, the nurse herself may 
become obsolete. If this day comes, our " History " 
may be as a voice out of the Dark Ages. 



BIBLIOGRAPHY 

[Limited to material of propagandist or historical character, or dealing with 
education in the broad sense. Space does not permit a complete list of liter- 
ature on nursing, nor the inclusion of technical works.] 

GREAT BRITAIN 1 

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Josephine L. De Pledge. Westminster Review, Aug., 1894. 

The Need of a British Nurses' Association and of Stale Registration 
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Matrons, Nov. 21, 1887: at larger one, Dec. 10, and at full meeting, 
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The Matron, 1st An. Report, and The Registration of Nurses, 2d 
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The Necessity for Union amongst Nurses. Ethel Gordon Fenwick. 
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The Development of the Art of Nursing. Ethel Gordon Fenwick. 
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The Profession of Nursing. Ethel Gordon Fenwick. The Queen, 
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The History of Nursing. Ethel Gordon Fenwick. The Queen, 
1893. 

The Better Organisation of the Nursing Profession. Ethel Gordon 
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Workers, 1897. 

A Practical Standard of Nursing. Ethel Gordon Fenwick. 
First Annual Conference Matrons' Council, 1898. 

The Evolution of the Trained Nurse. Ethel Gordon Fenwick. 
The Outlook, Jan., 1900. 

Organisation and Legislation among Nurses. Ethel Gordon 

1 Thanks are due to Miss Beatrice Kent, London, for the compi- 
lation of an exhaustive bibliography which our limits do not enable 
us to use. 

^23 



324 Bibliography 

Fenwick. Read at Int. Cong, of Nurses, Buffalo, 1901, Transactions, 
P- 335- 

State Registration of Trained Nurses. Ethel Gordon Fenwick. 
Read at Women's Institute, Nov. 5, 1902. 

Trained Nursing as a Profession for Women from an Educational, 
Economic, and Social Aspect. Ethel Gordon Fenwick. Read at 
Int. Cong, of Women, Berlin, 1904. 

The Organisation of the Nursing Profession: By Its Members; By 
the State. Ethel Gordon Fenwick. Trans. Paris Conf., 1907, p. 
167. 

State Registration of Trained Nurses. Ethel Gordon Fenwick. 
Nineteenth Century and After, vol. lxvii., 1910, p. 1049. 

Report from the Select Committee of the House of Lords on Metro- 
politan Hospitals, Aug., 1890. 

Report, Select Committee on Registration of Nurses. House of 
Commons Papers, No. 281, 1904. 

The Queen's Poor. Mary Loane. 1905. 

Neighbors and Friends, 1910. Mary Loane. 

Voluntary Workers' Report of Poor Law Commission, and other 
books. Mary Loane. London. 

In Japanese Hospitals in War-time. Mrs. Richardson. Black- 
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UNITED STATES 

State Registration for Nurses. Louie Croft Boyd. Phila., 191 1. 

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Louise Darche, A Memorial. The Trained Nurse, Sept., 1899. 
L. L. Dock. 

A General Presentation of the Statutory Requirements of the Different 
States. Annie W. Goodrich. Amer. Journ. of Nursing, Sept., 19 12. 

Negro Self-Help in Hospital Work. Geo. C. Hall, M.D., Chicago. 

Report of Interstate Secretary to the American Nurses' Association. 
Isabel Mclsaac. Amer. Journ. of Nursing, Aug., 1912. 

The Educational Status of Nursing. M. Adelaide Nutting. 
U. S. Bureau of Education, Bulletin No. 7, 1912. 

The Department of Nursing and Health at Teachers College, Colum- 
bia University. M. Adelaide Nutting. Read at the Int. Cong, of 
Nurses, Cologne, 1912. 

A History of Nursing, 2 vols. Nutting and Dock. Putnams, 
1907. 

The Nurse in Education, Part II. M. A. Nutting and Isabel M. 



Bibliography 325 

Stewart. Ninth Year Book, Nat. Soc. for the Study of Education, 
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Editorial Comment, Sophia F. Palmer, Am. Journ. of Nursing 
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Reports of the Congress on Hospitals, Dispensaries, and Nursing, 
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Reminiscences. Linda Richards. Whitcomb & Barrows, Boston, 
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Nursing Ethics. Isabel Hampton Robb. Savage, Cleveland, 1903. 

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Circulars of Information, No. I. U. S. Education Bureau. 

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Medical Inspection in the Public Schools. Lillian D. Wald. 
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Educational Value and Social Significance of the Trained Nurse in 
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Plea for the Creation of a Federal Children's Bureau. Lillian 
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Nursing — Vocation for the Trained Woman. Lillian D. Wald. 
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The Doctor and the Nurse in Industrial Establishments. Lillian 
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FRANCE 

Le petit Personnel Medical en Angleterre et Reformes d, introduire 
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Dans les Hopitaux Parisiens. Georges Cahen. Rev. Polit. et 
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Conseil Superieure de V Assistance Publique-Rapport sur le re- 
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326 Bibliography 

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Florence Nightingale (O.M.). Anna Hamilton, M.D. La Garde- 
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Quelques Conseils de Mile. Nightingale sur les Hdpitaux et le Nurs- 
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La premiere Ecole Frangaise, systtme Florence Nightingale. 
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Plan pour les Cours Theoriques d'une Ecole Hospitaliere de Gardes. 
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GERMANY 

Sliefkinder der Sozialpolilik. Anon. Ernst Reinhardt, Munich. 

Die Staatliche Prufungsordnung fur Krankenpflegepersonen in 
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Die Schwester im Krankenhaus in Gegenwart und Zukunft. Char- 
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Notstand im heutigen Krankenschwesternwesen. Marie Cauer. 
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MISCELLANEOUS 

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Het Rapport van den Centralen Gezondheidsraad. J. C. Van Lan- 
schot Hubrecht. Nosokomos, Sept.-Oct., 191 1. 

The Fight against Tuberculosis through Dispensaries. Emmy 
Lindhagen. Stockholm, 1910. 

Florence Nightingale and the Reform of Nursing. S. Ribbing. 
Stockholm. 

Riforma delV Assistenza ospedaliera. Amy Turton. Rivista 
delta Beneficenzia Pubblica. 

FOR CURRENT HISTORY 

American Journal of Nursing, The, 226 S. 6th St., Phila., Penna. 

Australasian Tr. Nurses Journal, The. Sydney, N. S. W. 

British Journal of Nursing, The. 20, Upper Wimpole St., London. 

Canadian Nurse, The. McKinnon BTd'g., Toronto* 

De Vlamsche Verpleging. Antwerp. 

Epione, Kopmansgatan 6. Helsingfors, Finland. 

Kai Tiaki. Government Bldgs., Wellington, N. Zealand. 

La Garde-Malade Hospitalilre. 96 bis , rue Laroche, Bordeaux. 

Nosokomos. 13 Van Eeghen Str., Amsterdam. 

Nurses' Journal of the Pacific Coast. San Francisco. 



Bibliography 329 

Nursing Journal of India. Bon Espoir, Ootacamund, South 
India. 
Swedish Nurses* Journal. 25 Tunnelgatan, Stockholm. 
Tidsskrift f. Sygeplege. 50 Kronprinsessegade, Copenhagen. 
Una. Equitable Bldgs., Melbourne, Australia. 
Untcrm Lazaruskreuz. 22 Nurnberger Str., Berlin, W. 50. 



INDEX 



Acts of Parliament relating to 
nursing. See England 

Africa, iv, 222-228 

Campbell, Emily, work of, 
225; Chevalier, Mme., life in, 
226; Dufferin Fund in, 226; 
English nurses in, 222; Ger- 
man deaconesses in, 223; 
Henrietta, Sister, work in 
Kimberly, 226; state registra- 
tion of nurses in, 226-228; 
training natives in, 224; 
Universities Mission, 225 

Almshouse nursing reform. See 
U.S. 

Aletrino, Dr. and Mrs. See 
Holland 

Allerton, Eva. See U. S. 

All Saints Sisters. See India 

Aloysius, Mother M. See Ireland 

Ampthill, Lord. See England 

Army nursing. See name of 
country. 

Australia, iv, 172-189 

Adelaide General Hospital, 
176; Alfred Hospital, 174; As- 
sociations of nurses in, 177- 
179; Australasian Trained 
Nurses' Association, 177-178, 
182; Brisbane Hospital, 176; 
bush nursing, 186; early nurs- 
ing history in, 172-174; Farqu- 
harson, Miss, 174; Melbourne 
Hospital, 175; mental nursing 
in, 181; McGahey, Susan, 
work of, 174; midwifery in, 
189; Nightingale nurses in, 
173-174; nursing journals of, 
184; organisation in, 177; 
Osburn, Lucy, 173; Prince 



Alfred Hospital, 174; public 
schools nursing in, 187; regis- 
tration: by the state, 182- 
183; voluntary, 180; Royal 
British Nurses' Association in, 
177; Royal Victorian Trained 
Nurses' Association, 177-179; 
Sydney Hospital, 172; Talbot 
Milk Institute, 188; Tasmania, 
Nightingale nurse in, 173 
Average working period German 
nurses, iv, 47 



B 



Baxter, Grace. See Italy 
Belgium, iv, 74-78 

Cavell, Miss, pioneer Matron 
in, 76, 78; Ecole beige d'lnfir- 
mieres diplomees, 76; muni- 
cipal schools in, 75, 78; outline 
of early history of, 74 _ 75; 
physicians' interest in nursing 
reform, 78; state registration 
in, 76-77; 
Bibliography, iv, 323-329 
Blackwood, Hermione. See Ire- 
land 
Bottard, Mile. See France 
Bourneville, Dr. See France 
Breay, Margaret. See England 
Brodrick, Albinia. See Ireland 



Canada, iv, 122-170 
Alberta, hospitals in, 141; 
army nursing, 149-150; Brent, 
Louise, 143; British Columbia, 
nurses in, 142 ; Catholic orders, 
training schools under, 124, 
137,139, 140; Columbian Coast 



331 



332 



Index 



Canada — Continued 

Mission, 142; early French 
hospitals, 123-124; educa- 
tional standards in nursing, 
158-160; Female Benevolent 
Society of, 135; first secular 
hospital, 125; French regime, 
122; Grey Nuns in pestilence, 
136-137; hospitals for child- 
ren, 143; Kingston Compas- 
sionate Society, 135; Living- 
ston, Norah, 129, 134; Mac- 
kenzie, Mary A., 166; Mani- 
toba, nursing in, 140* mental 
nursing, status of, 147-148; 
Milk Commission, 156; Mont- 
real, first training in, 126; 
General Hospital of, reforms 
in, 128-129; new lines of nurs- 
ing work, 161-162; Nightingale 
nurses in, 128; nursing journal 
of, 167; organisation in, 162- 
165; Ottawa General Hospital, 
137; post-graduate courses, 
158-161; preliminary courses, 
130, 138, 159-160; public 
schools, nursing in, 156-157; 
Robertson, J. Ross, 143-144, 
157; Royal Victoria Hospital, 
138 ; Saskatchewan, 141 ; settle- 
ment work, 156; Sisters of 
Hdtel-Dieu of Montreal, 138- 
139; Snively, M. A., hos- 
pital work of, 133; public 
work of, 134, 159, 163; state 
hospitals, 144-149; Toronto 
General Hospital, history of, 
130; training school of, 131- 
132; tuberculosis nursing, 157; 
Victoria General Hospital, 
134; Victorian Order of Nurses, 
the, 1 51-155; Winnipeg Gen- 
eral Hospital, 140; Yukon, 
nursing in the, 142 

Canadian Presbyterian Mission. 
See India 

Catholic Nursing Orders; atti- 
tude toward registration in 
Belgium, iv, 77; in Germany, 
iv, 30; in U. S., iii, 149; Cana- 
dian hospitals, work in, iv, 
124; plague service in Canada, 
iv, 136-137; revival in Ireland, 
iii, 85; statistics of health, 



middle Europe, iv, 37; status 
in France and Italy {see those 
countries) ; training school 
work of. See Canada, Ireland, 
and U. S. 

Celli, Anna. See Italy 

Chaptal, Mile. See France 

China, iv, 277-285 

Central China Medical Asso- 
ciation gives certificates, 283; 
Chesnut, Dr. Eleanor, work 
and death of, 281; Chinese 
nurses in associations, 282; 
in hospital positions, 279; 
Chinese training school at 
Tientsin, 284; Chung, Miss, 
Matron of, 284; early nursing 
work in China, 277; Elisabeth 
Bunn Memorial Hospital, 278; 
Hart, Mrs. CM., 283; Kin, Dr. 
Yamei, hospital work of, 284; 
Margaret Williamson Hospi- 
tal, 278; Nurses' Association 
of China, 282; St. Luke's 
Hospital, Shanghai, 278; Tip- 
pett, Miss C. F., on mission 
work, 281; uniform standards 
of training proposed, 282 

Corea, pioneer work in, iv, 285 

Cuba, iv, 288-307 

American nurses in, 298; 
Cuban nurses at London 
Congress, 302; Dept. of Chari- 
ties and Nursing, 296; emer- 
gency work of Cuban nurses, 
305; first in hospital posts, 
299; Hibbard, Eug6nie, career 
of, 300;- organisation work 
of, 295; hospital conditions 
at end of war, 288; Kean, 
Maj., share in nursing reform 
of, 293; mental nursing, 303; 
Mercedes Hospital first train- 
ing school, 291; O'Donnell, 
Mary A., first training school 
superintendent, 292; organi- 
sation in, 306; preventive and 
social work, 300-301; regula- 
tions of training schools, 296- 
297; reorganisation in Cuban 
hospitals, 290; state registra- 
tion established, 297; training 
schools opened in sequence, 
292 



Index 



333 



Deaconesses. See name of 

country- 
Delano, Jane A. See U. S. 

Denmark, iii, 254-263 

Danish Nurses Association, 
258-259; activities of, 261; 
petition to Minister from, 262 ; 
Deaconess Institute, 254; Fen- 
ger, Dr. C. E., work of, 256; 
Lutken, Cecilie, 258; Norrie, 
Charlotte, 259; nurses' journal, 
262; Red Cross organisation, 
256-257; rural nursing reform, 
258; St. Lucas' Institute, 256; 
Tscherning, Mrs. Hermy, 259 

Department of Hospital Econo- 
mics, iii, 132 

District nursing. See name of 
country 

Doria, Princess, iv, 107, no 

Drown, Lucy, iii, 128 

Dufferin, Countess of. See 
India 



Eight hour day in hospital New 
Zealand, iv, 219; U. S. iii, 135 

Elston Catharine. See France 

England, iii, 1-61 

Acts of Parliament relating to 
nursing: Asylum officers' su- 
perannuation, 8; Education, 
28; Midwives, 27; Notifica- 
tion of births, 27; Poor law 
officers superannuation, 4; 
Ampthill, Lord, champions 
registration, 58; Army Nurs- 
ing, 19; Breay, Margaret, in 
suit against officers R. B. N. 
A., 50; in work for Matrons' 
Council, 53; British Journal 
of Nursing, 34; British Nurses' 
Association founded, 33; City 
financiers' scheme to control 
nurses, 57; district nursing, 
beginnings of, 23; Fenwick, 
Mrs. Bedford, organisation 
begun by, 32; government 
service, nurses in, 18-21; Guy's 
Hospital, difficult reforms at, 
2; regulations of, 13; Holt- 



Ockley system, 25; Hospitals 
Committee, policy of, 37; 
Hughes, Amy, 27; lady pupils, 
13; Leagues founded, 54; 
Loane, Miss, 30; Local govern- 
ment board, 4, 8, 9; Loch, 
Miss, 20; Manson, Ethel 
Gordon (Fenwick), 31; Ma- 
tron, the, 16; Matron's Council 
founded, 52; mental nursing, 
21-22; midwifery, 30; Monk, 
Katherine, 2; National Coun- 
cil of _ Nurses founded, 55; 
nurse inspectors, 9; Nursing 
Record, The, 34; Pearse, Helen, 
28; pioneers in nursing reform, 
1-2; Plaistow nurses' home, 
26; Poor Law infirmaries, 3-6; 
preliminary training, 12; pub- 
lic school nursing, 27; Queen 
Victoria's Jubilee Institute, 
17-22; relief of sickness, how 
organised, 3; royal charter 
gained, 42-43; Select Com- 
mittee on registration, report 
of, 56; State registration pro- 
posed, 36; State Society for 
registration formed, 55; Stev- 
enson, Louisa, 56; Stewart, 
Isla, 52 ; struggle for organisa- 
tion, 30-60; Twining, Kathe- 
rine, 26; Louisa, 7; union of 
forces to work for registration, 
58; village nurses, 25; work- 
houses order in nursing, 8 



Fenwick, Ethel Gordon. See 
England 

Finland, iii, 263-275 

Association of nurses of, 273- 
275; Broms, Anna, 270; early 
nursing in, 263; first general 
hospital in, 265; House of 
Deaconesses, 267; Karamzine, 
Mme., 267; Lackstrom, Mrs. 
Olga, 27 1 ;Mannerheim,Mme., 
271; Nightingale, advice and 
gift of, 274; nursing journal 
of, 275; preliminary training 
in, 274; Saltzmann, Dr. F., 
269; Sister Lina, 268; Surgical 
Hospital, Helsingfors, 270; 



334 



Index 



Finland — Continued 
three years' course established, 
272; University Clinics train- 
ing school, 272 

France, iii, 279-340 

Army nursing established, 325 ; 
Augustinians in Boucicaut 
Hospital, 340; leave Hotel- 
Dieu, 279; Bordeaux schools, 
316; Bottard, Mile., life of, 
284-285; Bourneville, Dr., 
story of, 289-291; Bru, M., 
novel by, 337; Chaptal, Mile., 
work of, 339 ; Circulars, official, 
on nursing, 330-331; early 
reforms in nursing, 282-286; 
early^teaching of nurses, 295- 
296; Ecole professionnelle, new 
school in Paris, 334, 338; 
Elston, Catherine, work of, 
309; Hamilton, Anna, at Con- 
gress Public and Private 
Charities, 332; letter from, to 
Red Cross International Com- 
mittee, 326; personality of, 
299; story of, 300-305; La 
Garde- Malade Hospitalise, 
328; Lande, Dr., active re- 
forms of, 310; death of, 329; 
Luigi, Mile., at Beziers, 319; 
at Rheims, 320; Maison de 
Sant6 Protestante, 305-308 ; 
Mesureur, M. G., article on 
nursing reform, 334; municipal 
courses for nurses, Paris, 292 ; 
provinces, 331 ; new school for 
nurses, Paris, 334; Nightingale 
influence of, in France, 299; 
nursing journal, Bordeaux, 
328; Nectoux, Mile., in Albi, 
321 ; numbers of nurses, Paris, 
329; organisation of Paris 
hospitals, 335; Pasteur, influ- 
ence of, 280-281 ; problems of 
Paris hospitals, 337 ; provincial 
hospitals, Bordeaux nurses in, 
319-320; public school nursing 
in Bordeaux, 328; in Paris, 
339; Red Cross methods of, 
306, 308; Regnault, Dr. Felix, 
on hospital system, 333; regu- 
lation of May 1, 1903, 334; 
Sabran, M., views as to Ma- 
tron's position, 333; School of 



the Rue Amyot, 297; Sisters 
of Mercy in Pasteur Hospital, 
340; St. Andre\ nurses' diary 
in,3i3;training begun in , 3 1 1 - 
312; Tondu Hospital, train- 
ing in, 315; visiting nurse in 
Bordeaux, 327-328 



Germany, iv, 1-5 1 

Arendt, Sister Henriette, 
author of White Child Slaves, 
34; average working period of 
nurses in, 47; Catholic nursing 
orders in, 2; numbers of, 51; 
Diakonie Verein, 5; Eppen- 
dorf-Hamburg nursing associ- 
ation, 3; Free Sisters, the, 7; 
German Nurses Association, 
branches of, 21, 33; founded, 
16; growth of, 20; relations 
with Dusseldorf Hospital, 
26; with Frankfort City Hos- 
pital, 23; Hecker, Dr., article 
by, 51 ; Kaiserswerth and Cha- 
rity, 36; Karll, Agnes, early 
articles by, 8; letters of, 30- 
32; principles urged by, 9; 
story of, 10-24; Lazarus cross 
chosen as symbol, 25; legal 
status of nurses, 48 ; morbidity 
and mortality statistics of 
German Nurses' Association, 
39-46, of Von Lindheim, 37; 
Nightingale nurse in Germany, 
3; nursing journal founded, 24; 
numbers of nurses to patients, 
49-51; overstrain among 
nurses, 36, 38; Red Cross 
motherhouses, 4; Reichel Frl., 
investigations of, 48; social 
service and new lines of work, 
33 - 34; State registration at 
Charite\ 18; conference on, 29; 
established by Bundesrath, 27; 
standards of, 28-29; St. John, 
order of, 6; Storp, Elisabeth, 
pamphlet by, 11; Unterm 
Lazaruskreuz, 24; opposition 
of Red Cross to symbol, 26- 
27 ; Victoria House, 2 ; Virchow 
proposals of, 2; Wiesbaden 
meeting passes resolutions, 



Index 



335 



Germany — Continued 

14-15; woman movement and 
nursing reform, n, 30 



H 



Hampson, Sara. See Ireland 
Hampton, Isabel, See U. S. 
Haughton, Louisa. See Ireland 
Henley, hospital poems, iii, 68-69 
Holland, iv, 55~74 

Aletrino, Dr. and Mrs., work 
of, 63; "Bond," the Dutch as- 
sociation for sick nursing, 57- 
59, 61 ; early nursing conditions 
in, 55; Maandblad, hospitals 
journal, 59; Matrons, weak- 
ness of, 59; Nosokomos, nurs- 
ing journal, established, 62-64; 
headquarters of, 74; Reyn- 
vaan, Miss, work of, 57; state 
registration demanded, 68; 
government report on, 72; 
medical men's attitude toward , 
69; state registration society 
formed, 74; van Lanschot 
Hubrecht, Miss, work of, 64; 
viewpoint of, 65-67 
Huxley, Margaret. See Ireland 



India, iv, 229-256 

Albert Edward Hospital, Kol- 
hapur, 246; All Saints Sisters, 
244; American Evangelical 
Lutheran Mission, 247; As- 
sociation nursing superinten- 
dents of India, 249; Cama Hos- 
pital, Bombay, 241; English 
Baptist Zenana Mission, 248; 
first training school for native 
nurses, 241; midwifery, status 
of, 239; Mills, Miss, 245; 
Minto, Lady, nursing associ- 
ation, 251; missions advance, 
231 ; National Association sup- 
plying medical aid, 233; ob- 
jects of, 235; Nightingale, 
writings on India, 229; North 
India School of Medicine, 245; 
Nursing Journal of India, the, 
249; organisation in, 254; 
plague nursing incident of, 



243-244; registration in Bom- 
bay Presidency, 251; in Nurs- 
ing Journal, 250; Seva Sadan, 
the, 252; Thorpe, Winifred, 
255; Tindall, Miss, 242; 
Trained N urses ' ' A ssociation, 
249; uniform training, work 
toward, 250; U. F. Church of 
Scotland Mission, 248; Zena- 
na Bible Mission, 242 

Ingenbohl. See Switzerland 

International Council of Nurses, 
inception of, iii, 54 

Ireland, iii, 82-115 

Aloysius Mother, testimonials 
to, 100-101; Brodrick Albinia, 
work of, 115; Catholic orders 
training school work of, _ 97, 
104; Children's Hospital, 
Dublin, 98; City of Dublin 
Nursing Institute, 96, 104; 
Dun's Hospital and Nursing 
Institute, 93; early hospital 
history, 82-84; first school 
for Catholic nurses, 92; Han- 
nan, Miss, work of, 102; Irish 
Nurses Association, 110-113; 
Irish nursing journal, 113; 
Kelly, Miss B., work of, 92, 
97; MacDonnell, Annie, work 
of, 95; Mater Inf. Hospital, 
Belfast, 101; Mater Miser., 
Dublin, 100; Mercy Hospital, 
Cork, 99-100; Nightingale 
Nurses in, 91, 95, 103; Pringle, 
Miss, work of, 102; Queen's 
nurses in Ireland, 106-108; 
Queen's Nurses' Magazine, 1 10; 
Religious orders, revival of, 
85; Rotunda Hospital, changes 
in, 95; Sister M. Albeus Fo- 
garty, 102-104; Sisters of 
Charity in Cork, 86; in Dub- 
lin, 85; Sisters of Mercy in 
Cork, 86; to Crimea, 86; 
South Charitable Infirmary, 
Cork, 102; Steevens Hospital, 
history and nursing of, 83, 
88-92; St. Philomena's train- 
ing school, 101-102; Treacy, 
Mrs. Kildare, 107; Trench, 
Archbishop, work of, 87 

Italy, iv, 79-117 

Barriers to modern system, 86* 



336 



Index 



Italy — Continued 

Baxter, Grace, letters of, ioo- 
106; Blue Cross Society, ioo; 
Catholic orders, their nursing 
work, 82, 114; Celli, Anna, 
article on early conditions, 79; 
on later conditions, 81-85,1 14- 
115; comparative numbers 
of nuns and nurses, 114; Con- 
gress of Italian women, 107; 
passes resolution on nursing, 
108; Doria, Princess, 107, 109; 
Nightingale, Miss, influence 
in Italy, 89, 112; opening of 
new school for nurses, 112- 
113; Ospedale Gesu e Maria, 
Miss Baxter's work in, 99; 
Policlinico, Rome, field of new 
school, in; Scuola Convitto 
Regina Elena, 117; Snell, 
Dorothy, work of, 1 1 1 ; Stron- 
goli, Princess of, part in nurs- 
ing reform, 99-100; Tonino, 
Signorina, work of, 106; Tur- 
ton, Amy, a pioneer, 86; dia- 
ries of, 91-98; story of, 87-91, 
109-113; views of, on nursing 
in Italy, 11 5-1 16 



Japan, iv, 256-277 

American nurses in, 276; 
charity hospital in, 257; Civil 
hospitals, 274; efficiency of 
Japanese nurses, 276; first 
training school in, 258; Hagi- 
wara, Take, at London Con- 
gress, 259, 275; Nightingale, 
influence of, 277; Komeyo, 
Empress, legend of, 256; Mc- 
Gee, Anita, expedition of, 276; 
nurses in Reserve hospitals, 
274; Red Cross nursing organi- 
sation, account of, 260-273; 
Relief nurses, 262; Richards, 
Linda, in Japan, 257; sanita- 
tion, triumphs of, 275; Suwo, 
Choko, work of, 276; volun- 
tary nurses, place of, 265; 
visiting nursing, initiation of, 
277 

Journals of Nursing. See under 
countries and bibliography 



Labrador, coast mission of, iv. 

171 
La Source. See Switzerland 

M 

Mental nursing. See under name 

of country 
Midwifery. See under name of 

country 



N 



Negro nurses. See U. S. 

Newfoundland, nursing in, iv, 
170-171 

New Zealand, iv, 189-222 

Army nursing in, 222; Auck- 
land Hospital, 190; Back 
blocks nursing, 290; Christ 
Church Hospital, 195; coun- 
try hospital work, 221; dis- 
trict nursing, 211; Dunedin 
Hospital, 197; early history, 
189; first training school, 
194; government inspection 
of hospitals, 201-202; Kai 
Tiaki, 216; legislation on hos- 
pitals and health, 216-217; 
Maclean, Hester, work of, 
209, 215; Maori nurses, train- 
ing of, 213; mental nurs- 
ing, 218; midwifery, 206-208; 
Neill, Grace, work of, 202; 
Nelson Hospital, 200; nursing 
journal, 216; organisation of 
nurses, 215; R. B. N. A., 202, 
203; Seddon, Mr., tribute to, 
209; society to promote health 
of women and children, 212; 
state maternity hospitals, 207; 
state registration of nurses, 
203-206; Trained Nurses, 
Association, 215; tuberculosis 
nursing, 218; Wellington Hos- 
pital and matrons, 194-195 

Nightingale, Florence, comment 
on registration, iii, 43; death 
of, iii, 61; influence in Austra- 
lia, iv, 173-174; in Finland, iii, 
274; in France, iii, 299; in Ire- 
land, iii, 91-95, 103; in Italy, 



Index 



337 



Nightingale, — Continued 

iv, 89, 112; in Japan, 277; in 
Johns Hopkins Hospital, iii, 
122; in Sweden, iii, 240; Maga- 
zine, The Nightingale, iii, 119; 
Nightingale nurses in Austra- 
lia, 173, 174; in Canada, 128; 
in Germany, 3; in Ireland, iii, 
91,95, 102; in New Zealand, iv, 
200; in Scotland, 66, 72; in 
Sweden, 242 , 2 4 8 ; in Tasmania, 
iv, 173; writings on India, iv, 
229 

Norway, Red Cross nursing of, 
iii, 276 

Nurses Settlements. See U. S. 



Persia, Toronto nurse in, iv, 287 
Philippines, The, iv, 307-322 
American nurses in, 308; hos- 
pital organisation in, 308-309; 
McCalmont, Mabel, work of, 
315-321 ; men nurses for, 315; 
problems of public health, 311; 
Snodgrass, Mrs. E., death of, 
322; training school -ouiided, 

313 
Porto Rico, pioneer work in, 
iv, 307 



Queen's Nurses. See England 
S 



Scotland, iii, 61-82 

Aberdeen, Royal Infirmary, 
74-75; Allen, Dr., 78; Barclay, 
Miss, first trained superin- 
tendent, 66; Bell, Dr. J., 72; 
Deaconesses in Scotland, 68; 
district nursing pioneers, 23, 
75; Dundee infirmary, reform 
in, 67; early nursing history 
61, 66; Edinburgh, Royal In- 
firmary, 61-66; fever hospital 
nursing, 78; Glasgow Royal 
Infirmary, 70-71; Henley, 



hospital poems of, 68, 69; 
local Government Board, nurs- 
ing under, 76-77; Lumsden, 
Rachel, work of, 75; mental 
nursing, 80; midwifery, 80, 81; 
organisation, 81; Porter, Mrs. 
Janet, 68; preliminary courses, 
73 ; Pringle, Miss, work of, 72 ; 
registration movement in 
Scotland, 81 ; sanatorium nurs- 
ing, 79; Sinclair, Mrs., work 
of, 78, 79; Spencer, Miss, 72; 
Strong, Mrs. Rebecca, 67, 71, 
73; Western Infirmary, Glas- 
gow, 73-74 

Spain, iv, 11 7-1 21 

Foundation of Rubio Insti- 
tute, 117; training school in, 
118; Zomak, Sister Marie, 
work of, 120 

Sweden, iii, 237-254 

Army and nayy nursing, 250; 
Deaconesses in, 230; district 
nursing in, 250; early nursing 
history, 237; Fredrika Bremer 
Association, 247, 250; Insti- 
tute of deaconesses, 238; of 
deacons, 247; Lindhagen, 
Emmy, 252; nursing journal of 
Sweden, 251; organisation de- 
veloped, 252, Rappe, Emmy, 
240; Red Cross Society and 
nursing, 238, 240, 242; Rodhe, 
Estrid, 251 ; Sabbatsberg Hos- 
pital, 246; Samaritan Home, 
245; Sophiahemmet, the, 242, 
244; South of Sweden Nursing 
Home, 246; Tamm, Therese, 
253; tuberculosis work, 252 

Switzerland, iv, 52-55 

Deaconesses in, 54; Gasparin, 
Mme. de, 52; Ingenbohl, 
nuns of, 54; La Source train- 
ing school, 52-53; organisa- 
tion, 53, 54; Red Cross train- 
ing school, Berne, 53; Zurich, 
training school in, 53 

Syria, work of Miss Wortabet 
in, iv, 286 



Turkey, outline of pioneer work 
in, iv, 286 



338 



Index 



u 



United States, iii, 115-236 
Affiliation for training, 186; 
first examples of, 118, 123; 
army nursing bill, 211; Aller- 
ton, Eva, work of, 148; Alline, 
Anna, work of, 133, 152; 
almshouse nursing reform, 221, 
228; alumnas societies, 120; 
American Journal of Nursing, 
198-199; American-Indian 
nurses, 192-195; associated 
alumnae founded, 128-129; 
Buffalo Nurses' Association, 
147; Catholic orders and regis- 
tration, 149; Cleveland Visit- 
ing Nurse Association, report, 
2 33- 2 34; Delano, JaneA.,211: 
Drown, Lucy, 128. Edu- 
cation — action of Miss Ban- 
field on, 139; Beard, Dr., 
standards of , 139; Committee 
on, 132; growth of, 131 ; Hurd, 
Dr., attitude toward, 138; 
Isabel H. Robb scholarship 
fund, 134; Mills, Prof., action 
of, 139; report hospitals com- 
mittee on, 138; Teachers col- 
lege course, 131- 134; Texas 
university, action of, 139; three 
years' course, 135. Ethics, 
first book on, 119; examining 
boards, {see names of states) ; 
Fen wick, Mrs., in U. S., 125; 
Goodrich, Anna, work of, 153; 
Gretter, Mrs., in Detroit, 135; 
Hampton, Isabel, 122-126; 
health talks by nurses, 230; 
Johns Hopkins Hospital 
opened, 121; journals of nurs- 
ing, 198, 200; Lent, Mary E., 
paper by, 234; Maxwell, Anna, 
at Chickamauga, 205-210; 
Mclsaac, Isabel, work of, 201 ; 
mental nursing, 139-140; 
Naval Nurse Corps, 213; 
Negro nurses, 195-198; Night- 
ingale magazine, the, 119; 
Nurses Settlements, 215, 221- 
223; Nutting, M. A., work of, 
133-135; Palmer, Sophia F. 



H3 f H5» 147, H8, pioneer 
authors and nurses, 11 8-1 19; 
preliminary course, first, 134; 
public school nursing be- 
gun, 224; Red Cross Nurse 
Corps, 212-213; religious or- 
ders, 187-192; Robb, Mrs., 
129, 130-132, 134, 142, 146, 
202, 211; Rogers, Lina, work 
of, 224; school for district 
nurses, 231; Sisters of Mercy, 
Chicago, 187-189; Social Ser- 
vice in hospitals, 228-230; new 
lines of, 225-228; Society of 
training school superinten- 
dents founded, 127; Spanish- 
American war nurses organise, 
204; state registration first un- 
dertaken, 142-144; work for, 
in Cal., 159; Col., 160; Conn., 
161; D. of C, 162; Del., 175; 
Ga., 169; 111., 167; Ind., 158; 
la., 166; Md., 157; Mass., 182; 
Mich., 180; Minn., 166; Mo., 
179; Neb., 173; N. J., 154; 
N.H., i65;N.Y., 151; N. C, 
153; Okla., 172; Ore., 184; 
Penn., 175; Tenn., 185; Tex., 
174; Vt., 185; Va., 156; Wash., 
172; W. Va., 163; Wis., 185; 
Wyo., 171; statistics of train- 
ing schools, U. S. Bureau, 
1909, 141 ; St. Margaret, Sisters 
of, 190-192; St. Vincent, Sis- 
ters of, 187-188; superinten- 
dents in Cuban war, 204; 
undergraduate private duty, 
136; visiting nursing for in- 
surance company, 224-225; 
visiting nursing, growth of, 
234; Wald, Lillian D., work 
begun, 215; story of, 216-220; 
war service, 201-21 1; Welch, 
Dr. Wm., on registration, 158 



Visiting nursing. See name of 
country 



Zomak, Sister Marie. See Spain 



RT 
31 
F07 



BOSTON UNIVERSITY 



1 l?n D1177 DE3^